Luxating Patella – A Dog’s Trick Knee

 

Luxating Patella – A Dog’s Journey

(Scroll down for the latest post-op and recovery adventures!)

By: Skye the Golden Retriever along with Bonnie Sweebe
 

Hi! I’m Skye the golden retriever and I have luxating patellas. A luxating patella is also called a trick knee or a dislocated knee. A luxating patella actually refers to the knee cap or patella when it slips out of place. Luxate means dislocate and patella means knee cap. It causes discomfort, but the knee cap pops into place if I stretch correctly–and I’ve learned how. I was told this is a condition I was probably born with, but it was just recently discovered.

I will be journaling my experience from diagnosis through surgery to post-recovery and paws crossed, surgical success. There will be ups and downs but the goal of this journal is to educate and comfort other dogs who have been diagnosed with similar conditions–not to mention calming human nerves.

So read along and wish me well as I go on a journey of healing. Ready or not, here we go…

Tuesday, August 16, 2011 – Appointment with veterinarian for annual shots. I’m a two-year-old golden retriever that loves to run in the backyard and chase my four-year-old golden playmate, Sydney. Normally, running and tumbling isn’t a problem, but sometimes my knee caps pop out. It’s a shock and it startles me, but I’ve learned to compensate by stretching my leg until it pops back in. Until today, no one has noticed it. They’ve overlooked the fact that I climb slowly onto the couch, mistaking it as being polite and meek. But today, during my physical exam, the vet spotted the issue and referred me to a specialist. My journey begins.

Monday, August 22, 2011 – Appointment with the specialist. I knew this was going to be a strange day when I wasn’t given my morning breakfast. (That’s never a good sign.) I went on a long car ride instead, to the orthopedic specialist who examined my knees and mentioned that both knee caps were floating. My right patella or knee cap is a grade 2 (the knee cap slides out of place during activity, but slides back in place with motion). My left knee cap, however is a grade 3 (the knee cap slides out of place and is out more than it is in, resulting in minimal pressure being placed on the leg during activity) and must be surgically corrected. This is concerning.

Thankfully, I am going to a very good veterinarian who is a member of the Veterinary-Orthopedic Society and the International Veterinary Academy of Pain Management. He also reviews orthopedic studies for Veterinary Surgery, a big deal medical journal. Mom says I am in good hands. He is also a friend of a family friend and right now a friend is a very good thing to have!

Before I could explain to you exactly what my surgery would entail, I needed to have x-rays taken. For that, I was sedated. I don’t remember much of what happened and I certainly don’t remember this picture, but Mom said when I came home I went potty, found a cool spot and just passed out. I’m a real light weight.


My playmate, Sydney, was kind enough to come over and comfort me. Mom said she truly acted concerned. That is nice. Caring is good right now!


But when I woke up a half hour later and saw that Sydney turned the situation into a photo op, I knew things were back to normal. Sydney 1; Skye -0-.


The x-rays need to be read by the specialist. As soon as he’s examined them, he will give Mom a call with a surgical treatment plan. There are two surgeries: the easier one that secures the knee cap and the more complicated one that involves that AND correcting a bent femur (thigh bone). If I have to pick, I’ll pick option number one because correcting a bent femur sounds ouchy. I’m really glad that he’s a specialist in surgical pain management, too.

So now I just sit and wait for the phone to ring. I think I’m getting a stomach ache.

Tuesday, August 23, 2011 – The surgeon called. Stomach ache warranted. After reviewing the x-rays, I do have a bent femur and require the more extensive surgery. Why? Because if they perform the knee cap stabilization without the femur correction, the bend of the femur may cause the problem to reoccur. So if I am going to go through surgery, I may as well have the surgery that has the higher rate for stabilizing the patella (I do not want to go through this again!) and gives me the best chance for a better life. I do have a lot of life yet to live!

My surgeon will completely cut through the thickness of my femur bone. Then he will take out a wedge to correct the femur’s bend. After that, he will stabilize the knee cap and sew me back up. Of course I exclaimed that the whole thing sounded pawsitively painful!!! The surgeon assured me that cutting through the bone is not really painful, that a fracture to the bone is actually painful because of the surrounding damage to the tissue, etc. not because of the bone itself. But the surgery will involve some surrounding tissue and there will be pain and I will be on meds. (PHEW!)

I am trusting my surgeon who says that he probably performs this type of surgery more than anyone he is aware of in the state, and that the surgery has been shown to be well tolerated in dogs. There will be no physical therapy prescribed. I could do it at my discretion, but he hasn’t seen enough evidence that added physical therapy actually helps the recovery any more than what my body will do on its own. (I was looking for a spa package–rats!)

My surgeon said there is no immediate rush for the surgery, so I am going to get my human brother off to his last year of college and let Mom and Dad attend a friend’s wedding already scheduled in California before I go under the knife. Yikes!

The surgery will be scheduled for mid-October and I will keep you updated with text and photos, so do check in on me from time to time.

Til then, paws crossed!

Love,

SKYE

Monday, October 24, 2011 – My Last Night Luxating.  Mom made me this cool apartment right off the kitchen. That way, she can sit next to me at the kitchen table and I can hang out while she works.  It turned out really nice and I’m away from my golden sister physically, but I can still see what’s going on.  It is my last night with my luxating patella.  Will I miss it?  I’m worried.

Tuesday, October 25, 2011 – Surgery Day!  Ready or not, here I go.  We left for the hospital at 6 a.m. It was a 45 minute drive, plus paperwork.  They checked me in and off I went.  I don’t remember much after that.  I didn’t even hear the razor when it shaved my entire left side.  Later, Mom told me that the surgeon called around 2 p.m. or so.  He said that the surgery was a success and that I was resting comfortably.  I truly was. They had me on something called morphine.  I also received an epidural.  I was in no pain at all.

The surgeon explained the operation this way: A shallow groove was deepened to secure my patella (knee cap).  My tibia (shin bone) was then elevated to the outside.  My femur was not twisted as much as suspected, but still an adjustment had to be made.  He completely cut through my femur and straighten it.  Then he crafted a bone to accommodate the screws that will hold the new configuration in place.  My x-rays showed that both of my hips are solid.  He also said that my right knee is not perfect, but it should never need to be operated on.  Hooray!  My prognosis post-op is excellent.  The doctor is very pleased.  I would be too, but I am much too out of it.  I only drool…

Wednesday, October 26, 2011 – The morning after.  What a difference a day makes.  The epidural is wearing off. So is the morphine.  Ouch!  They have transitioned me to oral medication, Tramadol for pain, Rimadyl for pain and inflammation and the antibiotic, Cephalexin to ward off infection. I was surprised that the 6″ – 8″ long incision did not have a boo boo band-aid over it or an air cast.  Nothing.  My entire left side from my hip down to my ankle is shaved bare.  I can’t put weight on the boo boo leg and I feel a little loopy.  They said I ate dinner last night (don’t remember that) and I gobbled down my breakfast.  The oral meds are kicking in and I think I am going to be all right.

Potty time?  I’m supposed to get up?  Seriously?  But I did it and I tri-podded outside on leash and went potty. Potty now requires a whole different body position, but I figured out how to squat without pressure on my boo boo leg.  I did it!

Mom and Dad came to pick me up at 3 p.m.

I don’t look it, but I was so happy to see them.  They bought me a new toy and I got lots of hugs and kisses. After that, they took a closer look at my boo boo and the assistant told them about my medications, when I needed them and how to care for me when they got me home.  Here is a picture of my boo boo.

This is what I am allowed to do:  NOTHING!  For the next two weeks, I am to lay around in my apartment.  I can only go out on leash and I can only go potty and back.  Then I take my medication and lay down again.  For two whole weeks!  My golden sister is going to sit on the other side of the gate and torment me.  I’ll probably lose my mind.  But before I do, I see the surgeon again.  I don’t have stitches to take out (they are all inside), but he wants to see me to inspect the incision and make sure it is healing properly. Mom says he can also tell by looking at it whether I’ve been taking it easy or not.  So I have to lay here.

If all goes well, I’ll be allowed a little more activity.  Maybe a very short walk here and there but NO ROUGH-HOUSING or JUMPING for another six weeks.  That takes me to the end of the year.  New Year’s Day will be glorious for me.  It will be a new year with a new knee.  Until then, I take my drugs and await my two-week check-up.

Thursday, October 27, 2011 – Day Two Post Op

Diagnosis: Luxation-Patella-Medial-Grade III-Left
Procedure: Distal Femoral Osteotomy and MPL (Medial Patella Luxation)

Yesterday, I spent most of the day sleeping. I was alert and comfortable.

I found out some more details about yesterday. My Diagnosis was “Luxation-Patella-Medial-Grade III-Left”. During the operation, in addition to anesthesia, they performed a bupivacaine/morphine epidural so I didn’t feel the incision made on my left stifle. They surgeon deepened the trochlear groove, that part where the patella or kneecap makes contact with the femur or thigh bone. The patella (kneecap) is supposed to move up and down vertically along this trochlear groove. If it moves sideways, it produces PAIN!

My trochlear groove was not deep enough to hold my patella (kneecap) in place. My patella (kneecap) was floating (luxating) off the track all over the place causing pain. Sometimes my patella (kneecap) floated (luxated) so far off track that it couldn’t find its way back easily. Like a kid’s wooden train set, the groove was so shallow that there was nothing there to keep the train (my patella) on the track (the trochlear groove). Everything rubbed against each other and that could’ve caused cartilage is damage. Eventually, it hurt so bad that I was lame, not using it anymore because it hurt so much!

Misplaced ligaments were then relocated to the outside of the tibia (tibial tuberosity transposition) and imbricated (overlapped).

Then they performed the osteotomy (cutting of the bone and removing a piece of bone). My femur was malformed/bent. If the femur wasn’t corrected and made straight, the bend of the femur (even with the deepened trochlear groove) could push the patella (kneecap) off track again. The bone had to be repaired.

The location of the part of the femur (thigh bone) down by my patella (kneecap) is the “distal femoral” part, and the “osteotomy” is the cutting of that bone. The femur was cut, a wedge of bone removed to allow for realignment and the two ends of the femur were rejoined now in a straight fashion (because of the wedge cut) and secured together with a fashioned bone plate and locking screws on the outer side of the stifle.

My medication regimen consists of:

100 mg of chewable Rimadyl per day

100 mg every 8-12 hours of Tramadol

500 mg of Cephalexin three times a day to ward off infection

Dasuquin® glucosamine/chondroitin sulfate twice a day for 6 weeks then once a day for life to decrease inflammation and joint damage.

So there you have it! I’m going back to sleep.

Friday, October 28, 2011 – What in the world is this!!!

I woke up with increased swelling, especially near my ankle, and this colorful display.

And this!!!

I wasn’t licking it. I swear. Mom took a picture and emailed it to the doctor.

He was not alarmed. He told her to apply warm compresses to my red inner thigh area. Within days the redness disappeared. That was weird.

Approximately November 1, 2011 – Stitches split!

Okay, so I was out pottying and pulled a bit and turned and oops—Ouchy! I hopped on three legs back into the house. Mom looked at my leg, took a picture, and emailed it to the doctor. I hope I’m not in trouble.


I was told to rest and was given another round of antibiotics for infection, just in case. In two days, it started to scab up again. Phew! I must behave myself.

Wednesday, November 9, 2011 – Two Week Post Surgery Check-up

I got out of the house!!!

Well I’m back from my first road trip since my surgery! I’m exhausted. The veterinary hospital floor sure is slippery. It was hard to keep upright and I kept wondering if I would slip and screw up my knee. But everyone was careful with me and the appointment went very well.

Prior to surgery, my lameness was a 4 (not using the leg at all). Now, my lameness is a 2 (using it slightly and limping). The doctor took me into the exam room and fully extended my knee. It felt strange but the doctor said I had no pain and good range of motion. I still hop with it bunched up, though. I’m not convinced quite yet.

For the next six weeks, everything remains the same. I have restricted activity in a confined area and should be crated when not watched. No playing with Sydney. Small walks on leash only with a 10 minute maximum for potty purposes only, then back to confinement. I just might lose my mind!

I am allowed to take a bath now. The stitches are healed. Big deal, right?

So my next appointment is December 21st. They will drug me and take x-rays. That means no food in the morning and my appointment isn’t until 2:30 p.m.!

Hopefully, four days later in my Christmas stocking I’ll receive a new ball and can go play again! Paws crossed!

Saturday, December 3, 2011 – Five and a Half Weeks Post Op:  Here I am again.  No change.  Do you see a change?  I don’t see a change.  I’m being really good but I am so bored that I think I’ve lost my mind!

luxating patella post op

Tuesday, December 13, 2011 – Visitation:  I was granted supervised visitation today.  It was wonderful.  I am so bored.  Did I tell you how bored I am?  What would I do without my West Paw Bumi?

luxating patella

Wednesday, December 21, 2011 – 8 Week Post Op Appointment with Surgeon:  I haven’t had anything to eat today and it is 2:15 p.m.  I’ve learned that no breakfast means I am going to get stuck with a needle.  Good times.  I’m kidding!

When we arrived at the vet hospital, the surgeon injected me with a drug that put me to sleep.  Then he took radiographs of my left leg, the one that had the surgery.  He put me out so that he could properly position the leg.  He also did it because he was planning on yanking it a bit and checking for mobility.

When the radiographs were taken and the exam was over, I was given another drug to wake up.  My left leg was a bit sore and I was really groggy.  Mom was allowed to take me home to my confined space to rest.  I ate dinner six hours later.

Mom said that doctor said that the radiographs showed that everything was in the proper position.  (Then why does it hurt to walk?)  He said my mobility was good, that I had a little arthritis in the surgical area already (and I’m only two!), so I would have to keep taking one tablet daily of Dasuquin for the rest of my life.  It will help decrease inflammation to the area and make my joints more comfortable.  He said that the knee of my other leg, the right leg, was popping in and out.  We already knew that and it wasn’t as bad as the left leg.  The doctor said to watch it and if I discontinued using the right leg, I would have to go through this again on the right leg.  You don’t want to know what I was thinking when I heard that.

The doctor gave me a schedule to follow for the next seven weeks.  It is as follows:

December 21 – 28, 2011:  I get to go on longer leash walks, 15 minutes besides the regular potty breaks.  I am also allowed free access to the first floor of the house.  I can try to do stairs, just a few and on a controlled leash.

December 28 – January 4, 2012:  My leash walks can be increased to 30 minutes.  If I show any signs of discomfort, I am to scale back again.  It is better to do several short walks than one big 30 minute walk.

January 4 – 11, 2012:  My leash walks can be increased to 45 minutes total, split up.

Janaury 11 – 25, 2012:  We do just what we were doing last week, but now on a retractable leash.  Mom hates retractable leashes, so she’ll probably use the longer green leash.  I can also have free roam of the entire house.  Woo hoo!

January 25 – February 7, 2012: If I am comfortable with it, I can go off leash WITH supervision.

February 8, 2012: If I am doing well, I can resume normal activity.

What will normal be???

The remaining posts will be video clips of my progress as I don’t expect anything medical to be occurring and I have no further follow-up visits unless I wipe out on the ice and break the knee this time.  I thought the videos might be helpful if your dog has to have the surgery.  The visual will give you a better idea of what to expect.

And this video shows Skye one year post op, recovered and using the leg quite nicely.

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Bonnie Sweebe is a dog lover, dog owner, dog advocate, and rescue and service dog organization volunteer. She is also the owner of WelcomePup.com, an online dog gift delivery company.

 

50 thoughts on “Luxating Patella – A Dog’s Trick Knee

  1. I recently noticed that my 1 year old Golden would come up lame and I thought he hurt his hip. He runs at the beach and plays hard with his other golden friend. He came to me and leaned up against the couch and had his one leg lifted. I put my hand around his “knee” area and moved it a bit and I could hear a click and then he was fine. It has since happened about 5 times that I know of. I haven’t gone to the vet to ask but I believe it’s luxating patella. Thanks for posting so I can see the process of what I may likely have to go through with Milo.

  2. What you describe certainly sounds like a patella issue. However, I’d have the vet check Milo and get a professional opinion. If it is diagnosed as a luxating patella, it is unlikely that a stage one or two diagnosis in a young dog would require surgery. But knowledge is power and it is always best to have the issue checked out so that, if necessary, you can adjust Milo’s activities until the situation is remedied. Discovering this while the dog is young and before arthritis sets in is very fortunate. Keep us posted, if possible. We’re here to help each other.

  3. Best wishes to Skye and Milo.
    I have a 3 year old Golden and she is very active. Thank you for sharing this condition with us. I will be aware and watch out for this…

  4. Thanks Kevin! Check back here mid to late October. I will post pictures and describe the procedure to the best of my ability. You can watch Skye recover and we’ll see if this operation does the trick. We won’t know until six months from the surgery date. Paws crossed!

  5. Hi, everyone! I adopted Toby, a Boxer-Hound mix dog, who had 2 luxating patellas at age 2. He was given up by his original family bc the vets at Petsnot quoted $10,000 for the surgeries. My wonderful Vet was able to have a surgeon do both knees, one of which took 2 surgeries, for about 1/3 of that. And it’s a good thing, too, bc he is the world’s greatest dog.
    He required a bit of rest afterwards, but no PT. I do have to keep his weight down, which is not easy. He is fully recovered and 8 years old now. No problems ever with his legs! We were fortunate to have such a great Vet and wonderful Surgeon! Best wishes to all families who need this kind of therapy!

  6. Oh Maureen, how I appreciate your words of encouragement. As much as I know that this is what Skye needs, my stomach drops every time I think of what they must have to do to correct this. (Of course it didn’t help that I watched a partial YouTube video of the procedure.)
    Thanks for the virtual hand holding!
    So appreciated,
    Bonnie & Skye

  7. Thanks for taking the time to post such detailed info. My 10 yo pom has surgery in the am and I am soaking up all the info I can. I am nervous, but he is in good hands with my vet.

  8. Thanks for sharing yours and Skye’s journey with us. My dog is 4 years old and we adopted him from a shelter, he is a lab mix. We just had to get him surgery for a luxating patella on his left knee. Everything is so far so good but we are super super paranoid about every move he makes! So I just have a few questions since you have gone through this yourself! He just had his surgery today, is it ok if he takes a few steps and holds himself up to use the restroom? Also is it ok if he lays on the leg that the surgery was on? I’m just so worried because even if we try moving him he keeps laying on that side!! Thanks so much and have a great day.

  9. Hi Brittany! My surgeon told me to put her in absolute cage rest. She was only allowed out to potty and NO STEPS! She was allowed to try to use the boo boo leg to walk outside. In fact, they encouraged her to try and use it, but on a very limited potty basis. Then it was back to the crate. As far as laying on the leg, I let her lay in whatever position she felt comfortable in. Your dog is probably protecting its boo boo. Check the incision from time to time. Make sure the stitches are holding tight. Of course in a perfect world we would want the dog to lay on the other leg and let the boo boo leg heal and get air on the incision. But who knows what it feels like to have that kind of surgery. It may be more comfortable. Remember to be patient with the recovery and don’t do too much too soon. Follow your vet’s instructions carefully and check the wound for signs of swelling or redness and report that immediately to your vet. Best wishes for a solid recovery!

  10. Jade: Prayers going out to your pup. Please let us know how your dog progresses. I think everyone on this post will be thinking of you. Best wishes!

  11. I am happy that I read and watched this but also very nervous. I have a 2 1/2 year old puggle that was just diagnosed with a luxating patella. Her knee pops out about 6 times a day, even if shes just walking. This appeared to happen out of nowhere or it was always there and just got worse. I have an appointment with an orthopedic specialist in 3 days and am terribly nervous. Not only am I nervous about the possibility of surgery but the $$$ and the fact that she is so hyper that I cant imagine keeping her caged in and calm for 3 months. I have never had a dog so I am clueless about all of this. I dont know if I am making a big deal out of nothing. I just know that it breaks my heart to see her hop half way through a walk and then sit to pop her knee back in. Any words of wisdom would help

  12. Hi Kara!
    Thank you for your comments. I feel bad that you are going through this having never had a dog before. I wish I was a vet and could give you some advice, but I am not. I can tell you that Skye’s procedure was the worse case scenario and if they don’t have to cut a bone and just have to repair the patella, your cute little dog will have an easier time of it. Easier–not pain free–but that’s what the meds are for!

    These guys are resilient and if your doctor wishes your puggle to be crated for a length of time, please do it! If your dog doesn’t like the crate, it may whine and drive you crazy, but you are doing this for your dog’s own good. Six months down the road when your dog can walk without the kneecap popping off, she will thank you!

    Even if your dog is hyper in the crate, it is confined and hopefully will settle down. (I kept Skye’s crate by the kitchen table so I could sit with her and work during the day.) Knowing she is hyper ahead of time, talk to your doctor. Perhaps he could prescribe meds that could keep her calm. The crate time is for healing and if the knee doesn’t heal correctly it could compromise the surgical procedure.

    Have faith in your orthopedic surgeon (For him this is a common surgical procedure!) and be ready to take time off work the first week or have someone come in to be with her. The hardest part for me was when Skye was feeling better and I still had to keep her confined. She wanted to play with the other dogs at home, and it was then that I felt sad. But I’d give them visitation time and put one in her crated area which I expanded later to look like a crate and a small partitioned run area. That made her feel less confined. She could sleep in the crate and wander out to the partitioned area during the day. That helped. And unlike my dogs, you can always carry her to potty!

    I know this was a tough decision and you are afraid of the pain involved, but remember that the surgical site will heal. Every time the knee caps pops out it hurts! If it continues to get worse, you will have a lame tri-pod hopping around with a dangling leg and I know you don’t want that. The surgery will improve your dog’s quality of life in the long run. Focus on 6 months from now and how much better 2014 will be for your precious puggle! Think positively and breathe deeply.

    Keep me posted and best wishes!

  13. I cant thank you enough for writing back to me. Im sitting here crying at the simple fact that you wrote me back. We went to the specialist today and will hopefully schedule her surgery for this friday. We are going away on vacation from friday to friday so the first week after surgery she will be in medical boarding. We made this decision because my family was suppose to watch her while we were on vacation and watching her after surgery would have been too much on them. I am glad that she will be monitored while we are gone. So when we return it will be one week down!!!! Thank you again for writing back to me, it was a long day after finding out that she, in fact, does need the surgery, so seeing your reply was heart warming.
    If you dont mind me asking…where are you writing from (what state?) I am on Long Island NY.
    Thank you again,
    Kara

  14. The longer she stays in the hospital after surgery, the better chance they have to monitor and treat any infection that my arise from the sutures, etc. They will also be there to assist her in the initial days of pottying, monitor pain with meds and help her return to a normal diet. You are in a very good position. Now remember, do exactly what the doctor says as far as recovery is concerned. Not too much too soon, even if the cute little girl starts wagging that little tail. If the knee cap doesn’t slide off in six months and the surgery holds, she is good to go. Nothing should compromise that.

    It’s a pleasure to talk to you. I live in a suburb outside of Cleveland, Ohio, the city of some unfortunate fame of late. It is actually a great place to live! Feel free to ask me questions any time.

  15. Hi Bonnie,
    My husband and I just read your blog. We just found out that our lb mix has floating patella in both hind legs. We have just begun the process of getting a second opinion and finding the right vet to do the surgery. We\’re not sure how bad the knees are at this point. We do know that he hasn\’t torn any ligaments which is good! Anyway, reading your posts have given us a lot of information on what toe left in our near future!

    Thank you,
    Joanie and Aaron
    Charlottesville, VA

  16. Knee caps are not a part of the body that you pay much attention to until they don’t work. I have a brand new respect for the knee cap.

    When Skye was first diagnosed, I was told that floating patellas are uncommon in larger breeds, but as more and more people are commenting here, I think that is not the case.

    Let us know how your dog does with the surgery, if your experience was similar to mine or if you had an easier time of it. Breathe deeply, be patient and follow your surgeon’s advice and things should go well. Follow your post op instructions carefully and my very best wishes for a speedy and successful surgery!

  17. Hi Bonnie,

    I just wanted you to know how much comfort and hope this blog brought me. My husband and I just found out that our 13-month old golden retriever Josie has luxating patellas. It is worse in the right knee at this point, but still occuring on the left. Our vet said there is no ligament tear and at this point since she doesn’t seem to be in much pain, he has only recommended Dasuquin with MSM from NutraMax Labs. Do you feel like we should seek a second opinion as far as how to handle her current problem? She is only 1 and it breaks my heart that she has to go through this. She is so sweet, active, and playful and I want her to be able to have a great life! Also, should it progress to a point where we need surgery, what surgeon handled Skye’s surgery? I am so thankful she is a success story – it really gives us hope!

    Morgan Dykes
    Bethel, Delaware

  18. Hi Morgan! Thanks for your kind words. So sorry to hear about your pup. I remember being devastated when I heard the news as I was extremely picky about where I selected my puppy. Although the condition occurs more often in smaller breeds than larger, it is not uncommon to occur in larger breeds. You did not say whether the news was a total surprise or if you took your dog to the vet specifically for that reason (perhaps the dog was limping, for example). I bring this up because there are 4 grades of severity of a luxating patella. The first grade is when the patella can be manually manipulated off and back on the knee cap. The second grade is when the patella rolls off either to the inside or outside and the goes back on again (your dog might favor the leg or not until the knee cap is back in place). In either of these two stages, surgery is not necessary as there is often no pain associated with the temporary dislocation or slippage and the dog learns to stretch the leg and pop the patella back into place totally on its own. The dog could live its entire life that way without much if any discomfort. A grade three patella is when the patella is off more than it is on. It can still be manually manipulated back into place, and oftentimes is, but you will see the dog begin to bunny hop or limp. Seeing a surgeon for a grade three luxating patella is recommended. Grade four is simply when the patella is off and you cannot manually get it back on. Surgery is the only way to correct this problem. I said all that to say that if your dog is grade one or two, surgery may not be necessary. I do recommend you get a second opinion and a grade determination via x-rays. You’ll feel better if you get a second opinion. I sought out an orthopedic surgeon at Metropolitan Animal Hospital in Akron, Ohio for my confirmation diagnosis. Then we discussed realistic options and their costs. I decided to have Skye’s grade three knee done and left her other grade two knee alone. That decision is working so far. Sometimes when she sits, the leg slip out from under her so she isn’t 100% cured as if it never happened, but this dog went from lame to running so I’ll take a little slippage here and there (and remember, we also had the bone cut and repaired so her surgery is about as ugly as it gets). I hope this helps and let us know what you ultimately decide to do. To think your new pup is physically flawed is emotional indeed, but you and your pup are not alone. It helps us all to hear of the road you travel. Chin up! All the best.

  19. Thank you so much for getting back to me. We were very picky about where we got Josie from as well. We live in Delaware and got her from an experienced breeder in New Jersey. As a puppy, one or two times I noticed her holding up her back leg…but it was so rare I just thought she laid on it funny or something. One thing we always thought was weird though is that she didn’t jump onto furniture. She sleeps with us, so we tried to encourage her to jump on the bed because we knew eventually she would be too big for us to pick up and put on the bed…but she never would. In the past week though I have noticed her putting her right hind leg several times a day and then after a few minutes she took off playing again. She has obviously grown (she is 13 months and 68 pounds), she has been much more active since it is summertime, and she has a 9 month old boxer cousin she loves to play with. Thankfully though, she hasn’t seemed to lose any of her happy, playful personality. With her right hind leg, it pops in and out on it’s own several times throughout the day (so I guess that is grade 2). Her left hind leg is currently grade 1 I guess, because the vet said he was able to manipulate it, but it currently doesn’t seem to be doing that on it’s own…she hasn’t showed any signs of trouble with that one yet. But I am not sure how these things progress. We actually set up an appointment with an orthopedic surgeon in upstate Delaware on August 19. I can’t wait to go and hear what they have to say. It just breaks my heart because she is so young and I want her to have a full, happy, active life. I will be sure to update with any news from the orthopedic surgeon visit. Thank you again and tell Skye my Josie sends her love…Skye is keeping me hopeful that Josie will have a good life! :)

  20. Morgan, one more thing re the Dasuquin. Your vet is right on. After Skye’s surgery, they told me to give her one Dasuquin per day for the rest of her life to protect her cartilage and improve joint function-glucosamine chondroitin. Skye willingly takes the tablet for she loves the taste. Someone told me it tastes like liver. I wonder how they knew– ha ha! All the best.

  21. Bonnie – one more question!!

    What do you know about wrapping the knee with an ace bandage? Do you think it would help at all?

  22. Are you talking about wrapping the knee in lieu of surgery? I am not a vet so I cannot offer you any advice. I did not wrap the knee. The reason I did not is that prior to the surgery, even though the patella slipped off, Skye was able to stretch out her leg (Grade 3) and readjust it back on. If I were to wrap the knee and the patella would slip off, I would think the ACE bandage might restrict movement or repositioning to the point where Skye wouldn’t be able to get it back in place. Then she would’ve been in more pain. I would consult your veterinarian or the orthopedic surgeon on your visit.

  23. Okay, thank you. A couple family members thought maybe doing that would prevent the kneecap from slipping out as easily. I wasn’t sure, just trying to see if you had any experience with that. I undestand what you’re saying. I was just willing to consider it if there was any chance it would make her more comfortable. Anyway, thank you again for responding…I really appreciate it. Take care! :)

  24. Hi everyone. I just wanted to update you all on Josie. She had her “second opinion” appointment this morning. She met with Dr. Roberts in New Castle, DE and he was wonderful. He did highly recommend surgery on her right knee. We are not looking forward to the surgery or recovery process, but are proceeding with surgery in hopes that she will have the fully-active life that she so deserves! She is a young girl and we are hoping she will bounce back easily :) Her surgery is on Sept. 12.

    Thank you, Bonnie, for your encouragement during this process. We look forward to writing you in a few months with a wonderful success story ;)

    Best wishes,
    Morgan Dykes
    Bethel, DE

  25. Soooo, we are at a little over 3 weeks post op and I believe Lilly is doing well. We took her for her 2 week post-op appointment and they said all was healing well. They were surprised at the amount of pressure she was already placing on the leg. This is a good thing and a bad thing. They told us to keep her off her back legs (no jumping). That may sound easy to some, but restraining a jumping bean may be easier than getting my dog not to jump. As a result they gave us Xanax…that did nothing, so we had to upgrade to sedatives…that is kinda working (I guess my dog has a high tolerance for controlled substances). She seems unaffected at times and then at other times she is limping.
    Of all of the things that your page prepared us for, the one things that I am extra grateful for is your visuals of your confined area. Before picking her up from surgery, we created an area just like the one you had. It was perfect…We picked her up from the hospital, brought her home, and put her right in her \\\\”puppy fort\\\\” (as we like to call it). We lay with her in it at times and I do my reading for my masters classes in there with her : ).
    The one thing that was unnerving at the post op visit was when they told us that her other knee was popping out as well. What have you done regarding this? I know you said that Skye got the same news.
    Thank you so much,
    Kara, Tim, and Lilly

  26. Oh Kara, I am SO happy for you! It sounds like your pup is right on track.
    The first six months are critical for a good heal. Great job taking it seriously and doing what you can to get Miss Jumping Bean to settle. (You can wean her off the drugs later-ha ha!)

    Regarding Skye’s other knee, we haven’t done anything yet. She is not limping or holding it up and although it can pop off from time to time, she stretches the leg and repositions it without any sign of discomfort. So we are waiting. I am not doing it any sooner than necessary and hope that it never becomes necessary.

    Your report is so encouraging to me and to all who read this post. Thank you and keep us posted!

  27. Hi Bonnie
    Thank you for your detailed blog and videos – its is very helpful to have a reference, particularly as Skye’s recovery was perhaps slower than anticipated.
    3 months ago we adopted an absolutely adorable (but bonkers) Staffy called Kira who is having major problems with her left hind knee. She came to us already having had operations to correct luxating patellas on both legs. Both procedures seemed to have worked, and other than sitting a bit funny she was fairly normal. However she developed the limping in the left leg, and I noticed her leg clicking – sadly she had relapsed. We took her in to be assessed, and we made the difficult decision to have another crack at the surgery – I had no idea what I was in for. It has been a heart breaking experience, particularly as poor Kira has spent the first 2 years of her life almost in solitary confinement due to being in kennels / having operations etc. We are now 6 weeks on from the surgery, and she is not walking well at all. Her leg points outwards when she walks, she hobbles on it and picks it up occasionally when she walks a bit quicker. I noticed that these are similar traits displayed by Skye even after 9 1/2 weeks post surgery, which made me feel a little better as there is still hope that the operation has been a success. If you dont mind me asking, do you know why Skye’s recovery took so much longer than expected? My vet is worried there is a problem, as after 6 weeks she should be fully weight bearing and going for long walks etc. We are due to take her in for Xrays / examination under sedation next Friday and I am absolutely dreading being told that the operation has failed.
    Was there anything else you did to help Skye not mentioned in the blog above?
    Sorry for the long message, but I am so worried about this. Any info would be hugely appreciated!
    Thanks again
    Matt

  28. Sorry to hear about poor Kira. Skye didn’t have an unusually long recovery time. It was the appropriate amount of time to be certain that the knee healed properly. At anytime from surgery to six months after, if the healing process and exercise is not slow and certain, the knee can be compromised. After six weeks, Skye was only allowed a short fifteen minute walk. She was always on leash outside to potty and walk. I guarded that knee with my life and although it took time to become weight bearing, I never took her on long walks until I was past the six month window and the doctor said to resume activity. It appears my doctor and your doctor have differences of opinion as far as healing time goes. I’d be interested to hear what the doctor says. Please keep me and our readers posted. Best wishes for a complete healing.

  29. Thank you so much for the quick response!
    Yes strangely my vet seemed to think that after 8 weeks she could have 20 mins of free exercise and start hydrotherapy! I was pleasantly surprised by this, but then very disheartened when Kira has not recovered as expected.
    I too have been doing everything I can to protect her knee. She is still on lead constantly (except when I have her in the small kitchen with me whilst making dinner), and crated overnight / when we leave the house. The added complication is that she is so full of energy and very exciteable. Taking her for a walk is a nightmare as when she sees another dog / cat she goes loopy – I have to sweep her off her feet to stop her bouncing on the knee. My neighbours must think I am mad!! She is getting more and more exciteable as the weeks pass, and it is becoming harder to manage. She also gets very restless in her crate if we are at home, so we cant just leave her in there all the time.
    I am going to lean on the cautious side from now – walking her 2 or 3 times a day for 5-10 mins max. Hopefully no significant damage has been done, but with her being a Staffy her nature makes failure more likely. I certainly will keep you updated. Its great to be able to talk to other people in the same position, as it can get pretty tiring worrying about her knee 24/7!!
    I will let you know how she gets on. Thanks again

  30. My almost one year old 13 pound schnauzer/westie mix slipped last week on the icy steps. Over the weekend we noticed her limping and lifting hind right leg. Took her to vet Wed. morning and was diagnosed with luxating patella. That evening she slipped on hardwood floor and injured her left hind leg. In a matter of hours she went from healthy to collapsing on floor after only a few steps. Brought her to Tufts to see an orthopedic vet who did X-rays and said it was congenital and was surprised she wasn’t limping sooner. My dog always loved to hike off leash with me through the woods and had been running around until this past Tuesday. Was admitted Thursday and had bilateral TTT to repair both knees. Visited her today, they want to keep her a few days to make sure she is able to put weight on legs to potty. Absolutely heartbroken. To make matters worse, we are supposed to be going on a 2 week vacation 1/11/14, our son is coming and leaves for Air Force in Feb. and our daughter was joining us from Michigan( we live in CT). Our kennel would keep her but I don’t think I should leave her. Thought of taking her but the plane restrictions for carriers are small and she’s leggy for a small dog. Driving would also be very stressful for us both. At this point I think I’ll stay home with her and send the rest of family. My parents would watch her but I’m afraid she might slip again. So upset. I hope in 6 months this is just a distant memory.

  31. Bonnie,
    Thank you for sharing your blog with everyone. This last Thursday I noticed my fur baby, Roxy (14 month old golden retriever), limping and then just fall to the ground (we have wood flooring throughout our home). Of course, I rushed over to her and immediately massaged her leg and she just wailed. :( I rushed her to the vet. They did x-rays and they came up with nothing. Her hips, legs, and paws all look perfect. Im happy about that, but not so much leaving without a concrete diagnosis. She\’s so active and young. It breaks my heart that she is in obvious distress. Since then she will be fine one minute, and then limping again the next. My husband finally witnessing it decided to goggle knee dislocating. I was a bit calmer this last time it happened. I paid better attention to where the pain actually seemed to be, then a slight pop, and she was fine. Btw she doesn\’t wail anymore, she just carries on. I think the first time it happened it surprised her, and hurt of course. After reading your blog, Im pretty sure this is what is going on. I just pray now that I can find a specialist that is close and familiar with this type of diagnosis. Ill definitely be calling her vet tomorrow and see what he thinks. Thanks again, your story has been extremely helpful. :)

  32. You’re welcome Janene. Hopefully, if it is a luxating patella, it will be the first two stages that don’t require surgery. The fact that she can pop it back in and be on her way is a good thing.

    There is also a condition called Panosteitis. My one lab/golden had it when she was a puppy. She was limping and I took her to the vet. Panosteitis is basically growing pains of the long bone. It is a painful condition that may occur and reoccur in some dogs until they are approximately 18 months old. Sometimes it can be diagnosed via x-ray. Othertimes not. My lab/golden had it happen 4 times! It was painful and she limped. They gave her pain meds and in a few days it went away. It disappeared altogether at 18 months and has never returned.

    However, because you heard or felt the popping, the knee is probably the culprit. She can still have a long wonderful life. Let us know what the specialist says.

  33. Hi
    I am so happy I found your blog! I have a male 2 1/2 year old Golden who has LP in both knees. Last October, he has surgery on his right knee, and did an okay job with recovery, until now. He has been limping on it, and there has been a lot of swelling. We had him see the surgeon again, and unfortunately the surgeon does not know what is going on. We were told to rest him for three weeks. Unfortunately, resting does not seem to be helping him. Has anyone had complications like this after surgery, and if so, what did your vets/surgeons say?

    Thank you,
    Kelly
    Denver, CO

  34. Hi Skye!

    I was so happy to read your blog. You are such a brave dog…and funny too! I am Snowy, a 6-1/2 month old male Indian mix living in Bangalore, India rescued off the street by my foster mommy Lalita 2 months ago. Mommy says I have bilateral patellar luxation (grade 3-4) and will need both my legs operated on. It was first noticed 3 weeks ago when I couldn’t climb the stairs after my daily evening walk. Everyone thought it was a sprain, then when they saw my funny gait assumed it was my hips. Only an x-ray done a week ago confirmed that my kneecaps were slipping out.

    I am undergoing surgery for one leg tomorrow morning. I was a little worried (only because mommy seems so scared and anxious) but I showed her your blog and told her that it isn’t such a big deal and that it’s going to be okay. The vet says if all goes well with one leg, then I can have the second leg done 6-8 weeks later. Thanks to your blog, I now know what to expect and what’s going to be happening even when I pass out from the anesthesia. My elder bro Momo who is 1 year 4 months old and is also an Indian mix says he can’t wait for me to come home and play with him. But I’ve shown him your blog and how important it is for me to get rest when I am recovering. Momo doesn’t like it one bit but he’ll do it for me. :)

    Wish me good luck…will let you know how it goes. I’m scared but I’ll be brave!

    There’s one good thing that’s come out of this whole thing though – my foster mommy and daddy say they cannot even think of giving me away now and that I am now going to be a permanent part of this family. Ain’t that just great!

    Take care buddy!

    Lots of love and licks,
    Snowy
    Bangalore, India

  35. Good luck Snowy! Remember to do what the doctor says and take it easy. Momo, you will have to play with someone else until Snowy is back on her feet. Do not rush recovery–that is the key! You want the surgery to be successful. You are a young pup and will do just fine. You have a long and happy life ahead of you to run and play. A few months of taking it easy is so worth it. Please keep us posted and share your journey with all of us. We’re better together!
    All the best,
    Skye

  36. Thank you, Skye! I feel so much better now. Will let you know how it goes.

    ~Snowy

    PS – I’m a boy! :)

  37. Hi Bonnie. Thank you for your blog. This has been very helpful to us as we were just notified that our 14 month old golden retriever has a very similar situation as Skye. She has grade 1-2 in her left knee and 3 in her right knee with a bowed femur. They also believe she may have ACL damage. We are scheduled for surgery may 12 to complete the deepening of the groove, ligament repair, TTA+T, and the femur surgery. Needless to say we are a mess and so scared. She is our first puppy and I hate that she will be in so much pain. It is heartbreaking. She has already been on restricted rest for 3 weeks and now another 3 months. All she wants to do is go outside and play and take our walks. I feel that she thinks she is in trouble. Many tears have been shed on my part. We go for a cats can this Monday may 5 to have a better understanding of the degree of the femur bowing. From the X-ray they are saying about 17 degrees. Again, your blog has been really a blessing in helping us understand the process and the recovery. Any ore tips tricks u can offer please let me know. One question that comes to kind is that we have a large crate and I am wondering if we should but the charge so she has more room especially with a cone on. URG this is so nerve racking. Thank you Keri

  38. Thanks for your kind words. Actually, we are all learning together, aren’t we? Seeing she is the only dog, having a run or partitioned off area is convenient for recovery purposes (so that she doesn’t feel confined 24/7) but not necessary as when she comes out of the crate you will be there to watch her. If the crate is on tile floor, make sure there is a carpet outside the crate so that she doesn’t slide. Keep us posted and know we are rooting for you!

  39. Hi there,

    I’m always so thankful when I come across a blog that so nicely details things like this.

    My dog is a Pomeranian and had surgery 10 days ago on both of her knees. She has Grade 4 Bilateral Luxating Patella, ,and had to have “the works”, so to speak. My biggest fear is that the surgery fails (for whatever reason). We don’t see the surgeon again for another 2+ weeks, and I’m going to be a nervous wreck until we get that x-ray done.

    How long did you have to use pain meds (Tramadol)? We had to go to every 4 hours during the day for Sarah, and now I’m at every 12 hours, but I’m afraid that I may have backed off too quickly. When sitting, she holds one leg out to the side (way out). I mentioned this to the surgeon, and he didn’t seem the least bit concerned. *I* am concerned, though!!!

    I’m thinking about increasing her Tramadol again for a few days to see how it goes. Taking photos to email to the Vet is a fantastic idea. Why didn’t I think of that!?!?!?!??!

    I hope that this makes sense because I am soooooo tired right now!

  40. Hi Michelle!
    Thanks for sharing your dog’s story. I don’t remember how long Skye was on Tramadol, but I never refilled the bottle and followed the doctor’s orders. I think it was only used the first week. After a few days, if she wasn’t whining, I began to wean her off the meds. I do remember Skye holding her leg out for a time and even now that she’s healed, the leg is positioned differently when she sits or tries to potty. But that’s okay. Otherwise, you can’t tell. I think your dog may be adjusting her position to keep weight off the leg and lessen the pain as it heals. Things will change as she tries to use it more. Keep in contact with your surgeon or veterinarian and be patient. It is quite a long journey to recovery but it will get better. Slow steady progress is the key. No overexertion.

  41. Hi there. Well Fynn had surgery this past Monday – 3 surgeries to include TTA (ACL partial tear), femur bowing correction, and the luxating patella. She is a trooper for sure. She is on tramadol every 12 hours, rimadyl, and a antibiotic. We were also given a sedative to keep her quiet in the afternoon when kids come home. She has the redness and we have been doing the warm compresses but it is starting to get larger. She also has the swelling in her ankle. We have been massaging that. The doctor said to give her until early next week for the redness/bruising to subside and the swelling. She hardly goes out to the bathroom and is still on 3 legs. It is heartbreaking. I hope things will look up next week for her bearing more weight. I have been so nervous and anxious hoping nothing goes wrong and that this is all normal and will pass. Thanks for the info and listening. Keep me updated Michelle on your dogs progress. It takes a village and it is so nice to have a live blog to share tips/experiences. Keri

  42. Hi Keri!
    Deep breaths. This is a major surgery with a long slow recovery time, and we want it that way so the surgery is a success. Please be patient. Your pup had a partial ACL tear, too–a major ouchie, poor dear. I’m glad to hear Fynn is standing, even if it’s on three legs. I remember the swelling and redness during the first week and it was scary, but everything you’re experiencing I experienced with Skye. I know it’s heartbreaking, but hang in there. We’re all rooting for you guys! Have faith. The sun will come up tomorrow. Go Keri! Go Fynn!

    Michelle, how is Sarah doing?

  43. It is so nice to find such a detailed story about your experience. My baby Chester, 4 y/o poodle mix is going for surgery in 3 days. I’m already heartbroken about keeping him confined. He’s such a playful, active and happy dog :( it will be like a punishment for him having done nothing wrong :'( I’m getting ready with his recovery apartment. I hope he recovers well since I’m doing this so he can have a better life when he’s older.

  44. Our thoughts are with you and Chester. You are doing this so that he can have more happy, playful days in the future. It’s hard to think of the confinement of recovery, but you are giving him the chance to run and play for his many years ahead. Deep breaths and give him time to heal. The surgery’s success relies on a good recovery. Hugs to you both. Keep us posted.

  45. Hi! It’s been 5 weeks since Chesster’s surgery now. He seems to be doing well, he’s off pain killers, only having a Glucosamine supplement to help with joint mainteinance. He will have this for the rest of his life since the vet did find that the damage to the knee was far worst than he thought, some arthritis too. He had his leg inmovilized for the first 4-5 days. We also had to put our mattress on the floor since he’s used to sleep with my husband and I, not letting him in the bed was going to be just too much for me :(
    We are doing a couple of daily short walks. I was getting worried about the fact that he only uses the surgery leg when we go out, once we come back in the house, he uses it for a few seconds and then it goes back up… Just as Skye does on the 9.5 weeks video… So I guess I have to be patient and wait. It should be painful to have that “much” exercise on a leg that recently had surgery :S
    He actually started today to slightly stand on the surgery leg when doing number 1 which was very exciting since he used to go all the way around just to stand on the good leg. In the first few days after surgery he even managed to stand on the front legs, keeping both rear legs in the air… Ready to leave with the town circus!
    I was wondering, besides the walks, did you give Skye any additional treatment/exercise? My vet actually encouraged full movility for Chesster, it’s me who tries to keep him still around the house. Luckily we live in a one floor house.
    Thanks for sharing all of your post op experience with me! Say hi to Skye!

  46. Hi Jennifer!
    It sounds like a good recovery thus far! Hooray! I asked my surgeon if I should be doing any hydrotherapy to get the leg going and he told me that he’s read nothing to convince him that swimming or hydrotherapy will make the leg heal faster or better than just letting the dog use it as it naturally wants to, but if I wanted to do hydrotherapy, it was fine with him. I didn’t do it. I let Skye dictate the usage. The dog knows what he can and cannot do with the leg. 5 weeks is still a short way out. I don’t think I was allowed to give Skye full mobility (running around the house and out in the yard) for 5 or 6 months. She could go out to potty and then rest. Then she could go out and potty and walk around the house a bit and then rest. No running in the yard, that’s for sure. That 6 month healing period if very important. I like the mattress idea! I never thought of that! Good luck, nice job and keep us posted. Go Chester!

  47. Hi Bonnie, My 4 year old mutt had luxating patella surgery after displaying mild to more noticeable symptoms for 3 years. I agonized over the surgery decision and never got a diagnosis of grade 3 luxating until 4 months ago. She had surgery August 7, and of course I have been a wreck. Surgery went well, and she had moderate arthritis. At week 3 she got loose in the back yard and ran around for a minute that seemed like hours. I am so thankful for your blog, because she took a step back after her little jaunt. We see vet in 9 days and I am praying she did not re-arrange anything, but when I watch your first blog she seems to be doing ok. and I have watched it several times. Thanks again. I am so grateful for the extremely helpful info, and how is Skye doing? Chica is a high energy 35 pounder who looks like a pit bull, pug mix and acts like a jack Russell, so keeping her still has been a real chore because does not walk slowly and does not walk if she can run.
    Other than that run and a sneak trip up the stairs, rehab has gone well, but those mistakes hopefully will not hurt anything. Thanks again! How long did Skye take Rimadyl? We have metacam and tramadol.

  48. Sharon,
    I’ll bet you are glad the surgery is over and I’m so glad that Chica seems to be doing okay. Hopefully, Chica’s little romp wasn’t long enough or crazy enough to do any harm. I’ll be interested to hear what you veterinarian says. I don’t believe I refilled Skye’s prescription but cannot remember how long that initial dosage was for. I don’t remember thinking, “Skye seems to be is such pain that I’d better call the vet for more pain meds.” Let’s hope Chica continues to progress. Feel better soon, Chica!

  49. Hey Bonnie, Just an update on Chica. Went for 6 week post luxating patella surgery visit.I was so concerned because she had gotten loose at 3 weeks post and gone for a run. Vet said everything was fine and where it belonged. Overall vet felt things are going well, and now we move onto stairs with leash, longer walks, and several exercises to encourage equal weight bearing and to strengthen. The difference in muscle mass size of the two legs was 1 inch before surgery, and now there is half an inch difference, so that\\\\\\\’s a good thing. As the vet reminded me, she will have good and bad days during this phase, and just back off if she gets sore. Thanks again. One more visit in a month, and we should be good. Glad I decided to have the surgery, but what an experience.Your blog provided lots of information and comfort.

  50. Great news, Sharon!
    This surgery is a stinker indeed, but we all can get through it together. Looks like your outcome is right on target. There is nothing more reassuring to the readers than to hear of another successful outcome. Thanks for posting the news. You are providing encouragement to those coming here for the first time because they just got the diagnosis. Hope is a wonderful thing. Take care!

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