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Dear Dr. Walt: Our 3-year-old, female Italian mastiff inured her leg as a puppy when she fell on the ice. Rest and the use of Metacam (an anti-inflammatory medication) have helped her tremendously but this same leg seems prone to re-injury. We recently took her back to the vet, wanting to know exactly where the problem was as she was limping more often. By watching her walk, the vet told us that it wasn't her hip (which we previously thought) but rather her cruciate ligament. We were told a bit about the options: Metacam or surgery. She is now at the point where she can walk on her leg with a limp but if she wants to walk quicker, she goes on three legs. What we would like to know is if you can give us some infomation about the surgery (different options) and what the costs would be?

From what you describe, it sounds like your pet has injured or ruptured her anterior cruciate ligament (ACL). This ligament, in conjunction with the posterior cruciate ligament, provides internal stability to the knee joint and together with external support from the joint capsule and the collateral ligaments, ensures proper knee function. Damage to and rupture of the ACL is a relatively common orthopedic problem in the dog, although rare in the cat. The cause may be traumatic or secondary to an underlying joint problem, obesity, or other metabolic diseases (i.e., endocrine diseases, immune diseases, etc.). If an obvious trauma was not the cause, having your veterinarian perform a variety of diagnostic tests to investigate the root cause and its treatment is often helpful in providing for better healing following repair and to avoid a similar fate to the same ligament in the other knee. Although rest, Metacam, and time may allow for the other supporting structures of the knee (principally the joint capsule) to develop scar tissue and provide compensatory support, this is not a given. For most dogs suffering from this problem (especially large-breed dogs), surgery is the only realistic option available to try and return joint function to normal and avoid early onset arthritis in the affected joint. This approach would also allow your pet to get back to a more active lifestyle quicker.

Perhaps a good start would be to have your pet re-evaluated by your veterinarian. This would include both a physical manipulation of the knee joint involved, as well as radiographs (x-rays). If you haven't done so as of yet, investigating for a potential underlying cause is important (as outlined above). The good news is that since this is a relatively common orthopedic problem in the dog, many well-defined, tried and true surgical procedures exist to treat it - from ligament reconstruction to joint modification (tibial plateau leveling osteotomy). If it would make you more comfortable, ask your veterinarian for a referral to a veterinary surgical specialist. These are veterinarians who have had extensive post-graduate training and are exceptionally skilled at providing orthopedic diagnoses, prognosis, and suggested treatment options. Providing you with a specific cost is difficult as these will vary depending on where you reside, the type of procedure you have done, and the level of expertise you choose to perform the procedure. It is best to discuss both your options and the attendant costs with your veterinarian.

Dear Dr. Walt: Our cat disappeared for two days. We found her because she was wearing a tag and a neighbor called us. We are obviously nervous about letting her out again. Can we trust that she will return home in the future or should we try keeping her indoors?

Dear Dr. Walt: I have an outdoor cat that is having a problem adjusting to my neighbour's cat. They are always getting into fights and my cat seems to be on the receiving end of the abuse – he's always coming home with cuts, bite wounds, and some of these injuries progress to abscesses. Is there anything I can do to prevent these conflicts?

Both these questions have the same answer – it is best for your cat to be kept indoors. While opinions vary on this statement, the medical facts do not. Overall, cats kept indoors have less health problems because they are not exposed to situations that can cause harm (e.g., fights, injury by motor vehicles, etc.) nor spread infectious diseases (contact with other cats, wildlife, etc.). Provided with the appropriate play equipment (and I use the term 'equipment' as it is truly amazing the 'jungle gyms' available for cats) and interaction/play time, the majority of cats acclimatize well to an indoor-only environment. For others, having a confined, outdoor play area may provide them with the best of both worlds. There is no other way to ensure one avoids the potential for harm or getting lost. If you still decide to allow your cat's access to the outdoors, ensure the following:

• Annual vaccinations, on the recommendation/advice of your veterinarian. Discuss whether feline leukemia virus vaccination (an immune suppressing and cancer-causing virus) would be appropriate for your cat.
  
• Have your cat microchipped to increase your chances of having her returned should she become lost. If you elect to have a collar ID tag, make sure the collar is a tear-away design to ensure that the collar does not harm your cat if it becomes caught on an object.
  
• Consider discussing the current cat conflict with your neighbour - I am sure they are also experiencing the same concerns with their own cat. If one or both are not neutered, ensure this is done to reduce territorial aggression. Sometimes developing a cooperative, outdoor access schedule that avoids both being outdoors at the same time may help.
  
• Consider training your cat to walk on a leash - it can be done!
  

Dear Dr. Walt: I have a chocolate lab, and I was told "not" to have his anal glands done when I have him groomed, and that these glands in large breeds release on their own. Is this true?

The anal glands, found at the 2 and 10 o'clock positions around the anus, produce and secrete a particularly odorous liquid that dogs excrete with their stool to mark territory. For most dogs, these glands empty on their own with no need for assistance. For others, regular expression is important to avoid gland impaction and infection. Whether an individual dog needs assistance or not, only time will tell; regardless, have the glands examined at each convenient opportunity to be able to better decide in which camp your dog falls.

Back by popular demand!

It seems that there has been a rash of 'skunkings' as of late. I have had numerous e-mails from pet owners requesting the recipe to help remove this most annoying of odours from their pets.

Baking soda – 65 mL (1/4 cup)
Hydrogen peroxide – 1 liter (1 quart)
Liquid soap – 5 mL (1 teaspoon).

Mix the ingredients together, work into your pet's coat, and rinse off.

Some other pointers should your pet get ‘skunked'
1. Bathe your dog thoroughly with a regular dog shampoo first.
2. Try and avoid getting any product used in your pet's eyes. Bathe carefully in this area and cover the eyes with your hand when you rinse.
3. Never wear your best clothes to do the bathing, wear rubber gloves, and avoid, if possible, bathing your pet in the house – believe me when I tell you that this smell is hard to eliminate from anything it comes in contact with!
4. Ensure that your yard isn't attracting skunks with easy access to garbage.
5. Ensure you have your pets current on their rabies vaccine.

About Dr. Walt Ingwersen
Dr. Walt Ingwersen is Chief Veterinary Officer at PetCare Insurance Brokers Ltd. He is a 1982 graduate of the Ontario Veterinary College. Board certified in Internal Medicine, he has the distinction of being the first Canadian editor of the Journal of the American Animal Hospital Association, a position he currently holds.

Involved in many aspects of the national and international veterinary community, "Dr. Walt" is the recipient of the President's Award for outstanding contribution to the veterinary profession awarded by the Canadian Veterinary Medical Association (CVMA). He is also Chief Veterinary Officer and Chairman of the Veterinary Advisory Board at PetCare Insurance Brokers Ltd. – Canada's leading provider of insurance for dogs and cats.