MacKenzie was headed to the emergency room! He could hardly stand. He could only take a few steps before collapsing on the floor. In truth, his Mom and dad thought it was his time.

After all, the 11 year old Labrador Retriever had undergone his first major joint reconstructive surgery at 5 years of age and his second at 10. At 9 MacKenzie had undergone surgery to remove a malignant thyroid tumor. The fact that MacKenzie was already on two daily pain medications was another major concern. His family worried that nothing more could be done. They didn't want their boy to suffer so off to the emergency room they went with heavy hearts.

If MacKenzie had reached the emergency room I firmly believe that he would have been lost; too many veterinary practitioners lack the knowledge, skill, and optimism to manage complex pain patients. But MacKenzie never reached the ER....

The family gave me a call to let me know of the developing situation (716-650-4045). It was the 4th of July which meant that my staff was off and my facility was closed. However, MacKenzie needed to be seen. I instructed the family to meet me at my home where I performed a physical examination and made a pain and functional assessment. MacKenzie was in significant pain and was unable to walk any real distance. And yet, like almost all of the patients that we see, I was optimistic because we have so many tricks up our sleeves; many options that had not yet been incoporated into MacKenzie's management program.

MacKenzie's preexisting pain medication doses were adjusted and an additional pain medication, one targeting a pain receptor not yet addressed by his previous medicines, was added. Within 2 days MacKenzie had an improved attitude and was able to walk 20 feet. By the 6th day he was 50% better but he failed to budge past that point as we reached the 2 week mark.

At this point we repeated MacKenzie's orthopedic imaging to insure that no new disease elements had developed since his last review; degenerative disease was present along the spine and, in particular, in both knee joints.

We continued to develop MacKenzie's medication strategy, added Adequan injectable pGAG therapy, and, quite importantly, began twice weekly physical rehabilitation therapy. We also incorporated tight weight control limits. 6 weeks into his broadened program, MacKenzie was doing extremely well; he was much more mobile, was bringing the family members his ball to play with, and was tackling stairs without difficulty.

The 12 month mark came and went with MacKenzie continuing to do well.

In the end, MacKenzie came across a foe too great to vanquish. 17 months after his pain crisis, MacKenzie developed a twisted stomach (bloat) and, at 12 1/2 years of age, MacKenzie's family finally had to say Goodbye.

MacKenzie reminds us that despite being older, despite already being on several pain medications, when we conduct the best possible diagnostics and focus a balanced interdisciplinary management program on the patient's core problems, we are usually rewarded with such substantial life extensions that it can be stunning.