What health problems do Shih Tzu's have? The Shih Tzu suffers from most of the health problems common to tiny dogs and has a few particular health problems, but overall, it is a fairly healthy breed. Here we have listed the most common health problems and how your dog can live a healthy life even with health problems like these. If you are the proud owner of a Shih Tzu, these are the most common health concerns you should be familiar with:

1. What Health Problems Do Shih Tzus
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What health problems do Shih Tzus have? The Shih Tzu suffers from most of the health
problems common to tiny dogs and has a few particular health problems, but overall, it
is a fairly healthy breed. Here we have listed the most common health problems and
how your dog can live a healthy life even with health problems like these.

2. If you are the proud owner of a Shih Tzu, these are the most common health concerns
you should be familiar with:
● Progressive Retinal Atrophy
● Dental Disease
● Ear infection
● Breathing Problems
● Collapsing Trachea
● Hip Dysplasia
● Kidney Disease
● Back problems
● Floating Kneecaps
Progressive Retinal Atrophy (PRA)
Retinal dysplasia is a disease that occurs at the back of the eye when the
photoreceptors start to fail. You will find that this disease becomes apparent in your dog
at night, your dog will have night blindness.
It will be difficult for your Shih Tzu to get around when it gets darker, they will seem very
clumsy.
As this disease gets worse, it will also affect your dog’s vision in the daytime,
unfortunately, this can lead to total blindness.

3. Because this disease gets progressively worse your dog will adapt to its condition with
the help of your veterinarian.
Your veterinarian will advise you that there is, at the moment, no treatment for this
condition but it can be managed.
You should always pay attention to your Shih Tzus eyes as they are developing. If they
start to develop problems you will see that their eyes will become red or swollen, they
may also scratch their eyes.
If you notice this then contact your veterinarian right away so they can advise you on
things you can do to help your dog.
As we have previously mentioned your dog would not normally walk into furniture and
be generally clumsy, so as soon as you notice this unusual behavior then first check
your dog’s eyes to see if they are red or swollen and if they are, seek professional help
from your vet.
As I have already mentioned previously there is no known cure for retinal dysplasia,
some dogs may only have a mild form of retinal dysplasia but they can quite easily learn
to compensate and function normally around the home.
Other Eye Problems
Toy dogs like the Shih Tzu can also suffer from other eye problems like Proptosis.
Proptosis is a disease when the eyeball dislodged from the socket and the eyelid can

4. close behind it. This can be very painful for your Shih Tzu but can be repaired with
surgery.
If this is not repaired then you’re dog can become blind, the symptoms are inflammation
of the eye and the eye is moving forward in the eye socket.
As we have mentioned this can be repaired with surgery but it can be quite expensive,
so you may want to look at purchasing pet-insurance to mitigate any possible issues.
Another eye problem that your Shih Tzu may have is Epiphora. Epiphora Is used by
veterinarians to describe when your dog’s ears overflow and that causes the white fur
below the eyes to stain.
Other eye problems can include cataracts, ulcers of the cornea and other eye infections.
They can also suffer from entropion which is when one or both of the eyelids turn
inwards facing the eyeball.
This causes the eyelashes to continually rub against the eyeball which causes irritation
for your dog. In the most severe cases, there is surgery available to help.
If your dog’s eyes do show signs of excessive discharge or your dog is constantly
rubbing or scratching their eyes, then we would recommend that you have your dog
examined by a veterinarian who has some experience with eye problems.

5. If you notice your Shih Tzu experiences abnormal discharge or it keeps rubbing his or
her eyes, it would recommend having your veterinarian perform a physical examination
as soon as possible.
Dental Disease
Shih Tzus tend to have missing or bent teeth due to the size of the mouth. You should
get your dog regularly checked by a veterinarian because they are prone to periodontal
disease.
Three things that you can do to naturally treat your dog’s dental problems at home.
The first thing is brushing your dog’s teeth. You need a toothbrush and dental
toothpaste specifically for dogs, you can also use something such as baking soda but
never human toothpaste.
Human toothpaste is not safe to swallow and most of our dogs are going to swallow the
toothpaste.
When brushing their teeth you should focus on the gum line, right where the tooth and
the gum line meet. That, in particular, is where we’re seeing the bulk of the dental
problems and that’s gingivitis.
The second thing is something that your mother or grandmothers told you to eat more
of, that’s fruits and vegetables.

6. A great one for our dogs is carrots. Nutritious and they’re very firm, and just the act of
crunching is going to be abrasive and help break down that tartar. Apples are also great
but don’t let your dog eat the pips or core of the apple.
They’re both great fruits and vegetables, they’re healthy for our dogs as well and will
help decrease the amount of plaque and tartar.
The third thing is bones, especially a big bone. I think for all the things I’ve done for my
Shih Tzu to keep his teeth healthy he’s never had to have a veterinary scale and polish
because he had regularly raw meat bones.
Regular trips to your vet and brushing your dog’s teeth are very important to keep your
dog’s mouth fit and healthy.
Ear infection
Otitis Externa or external ear infection is an inflammation of the outer ear, that portion of
the ear from the eardrum outward. People have short hair canals that are open to the
drying effects of circulating air, but the canals of dogs are very different.
Dogs have longer ear canals that are L-shaped, the canals go down one to
one-and-a-half inches, then turn inward about the same distance to the eardrum.
The complex structure of the dog’s ear canal makes the inside of the ear an almost
perfect place for bacterial growth, allowing the infection to flourish under the right
conditions.

7. Lack of air circulation, the inability of fluid drained from the ear canals and darkness are
the reasons dogs with floppy ears, or dogs with hair growing in the ear canals are more
susceptible to infections.
Infection in your dog’s ear canal secondary to many situations, foreign objects in the
ears such as grass seeds, known as foxtail, allergic reactions that cause inflammation in
the ears, parasites such as ticks, ear mites or even fleas.
Moisture that remains in the L-shaped ear canal after swimming or bathing, floppy ears
or hair and ear canals that reduces circulating air and drying of the ear canals.
Some breeds of dogs are more likely to get ear infections because of their ear structure,
or a tenancy to have allergies. A dog with an ear infection is uncomfortable, its ear canal
organelles are painful.
The dog shakes his head trying to get the debris and fluid out and scratches at the ears.
The ears often become red and inflamed and develop an offensive odor, a black or
yellowish discharge is commonly seen.
Examination of the dog’s ears with an otoscopy allows the veterinarian to evaluate the
infection and to be sure the eardrum is intact.
The microscopic examination of a sample of the material from the ear canal helps the
veterinarian to determine what is causing the infection.

8. Sedation or anesthesia of your dog may be necessary when ears need to be cleaned of
wax and debris to allow a thorough examination, or when the dog is in extreme pain and
will not tolerate the examination.
Many times a bacterial culture test is performed to determine the cause of the infection.
The result of the examination and testing usually determine the course of treatment,
difficult infections may require several weeks of treatment at home and may require one
or more progress checks.
Chronic severe cases of otitis externa or ear infections can result in ear canal swelling
until it is nearly closed. If medication does not open the canal a surgical procedure may
be needed.
The vertical part of the ear canal and swollen tissue from the horizontal canal are
removed by this procedure. If the condition is extreme, another procedure called a total
ear canal ablation is used to remove all of the ear canals from the eardrum outward.
Nearly all your infections that are properly and promptly diagnosed can be cured, the
importance of frequent examinations at home and your vet’s office cannot be
overemphasized.
Untreated ear infections can cause serious complications such as rupture of the
eardrum, allowing the infection to spread to the middle and inner ear. This results in
problems such as nausea, dizziness, poor coordination when walking, and severe ear
pain.

9. Breathing Problems
People don’t know that dogs like the Shih Tzu’s suffer from brachycephalic airway
syndrome. Brachycephalic airway syndrome makes it difficult for dogs with compressed
faces to breathe normally while exercising, and at rest.
This is because of elongated soft palates that cause difficulty breathing and panting and
heat. Stenotic nares, or in other words collapsed nostrils, and even tracheal stenosis as
well or even the trachea collapses due to weight and compression.
These breeds have not always been this way, in fact, brachycephalic airway syndrome
is largely a creation in the last 100 years.
As breeders continually compressed the facial features of brachycephalic dogs while
allowing their sinus and oral tissues to remain the same, these problems were
exacerbated.
The result is that these same breeds look much different than they did 100 years ago
and their physiology is different as well.
Brachycephalic dogs not only have difficulty breathing, but they are also
oxygen-deprived because they cannot get enough air into their lungs.
This leads to low energy in these breeds, and an inability to meet the physical demands
put on them by their owners.

10. What’s worse is that many people continue to breed compressed features into these
dogs because they perform better in dog shows, dog shows that are slow to change
outdated and unhealthy traditional breeding standards.
The discussion of brachycephalic airway syndrome generally doesn’t take place among
breeders, this is because professional breeders shoot for Kennel Club and dog show
standards at the expense of the dog’s health.
This is why dog shows in kennel clubs are a good place to start in dealing with this
problem professionally.
Brachycephalic airway syndrome could be eliminated, this would require dog shows to
change breeding standards that select or compressed facial features in these dogs.
People purchasing a brachycephalic dog breed should research on brachycephalic
dogs before buying.
This is important for any breed, but more important for these dogs because of their
susceptibility to eating, exercise, and obesity. Dog owners should make sure their
lifestyle meets these conditions before buying.
Ask to see the owner’s medical records, every reputable breeder should have medical
records for the owners of their puppies. Checking the medical history of these owners
helps dog owners understand the risk their dog may have of illness.
Prepare financially. Brachycephalic dogs oftentimes come with a high price tag before
medical bills and expensive procedures to correct things like elongated balance and

11. stenotic nares add to that price. Good pet insurance will cover the cost of any
veterinarian bills.
Buying from a reputable breeder that understands these issues and is working to
reverse them in their breed is a must, in doing so dog owners can promote a healthier
future for all the dogs we love.
Collapsing Trachea
Tracheal collapse is a chronic progressive disease involving the windpipe or trachea.
The trachea is somewhat like a vacuum cleaner hose, it contains small rings of cartilage
that keep the airways open.
The rings are C shaped with the open part of the C facing upward, running along this
top opening is a band of tissue called the dorsal membrane.
In certain dogs, the rings of cartilage are either aren’t formed correctly from birth, or they
weaken and begin to change from more of a C shape to kind of a U shape.
As the dorsal membrane stretches that cartilage rings get progressively flattered until
eventually, the trachea can just collapse, leaving the dog trying to pull air through what
is basically a closed straw.

12. Signs Of Collapsing Trachea
One of the first signs of tracheal collapse can be a sudden attack of dry coughing that
sounds a little bit like a goose honk cough.
It progresses then from the goose cough into a more consistent cough. Initially, it can
occur when there’s pressure placed on your dog’s trachea, this can happen when the
dog is picked up or if the collar is being pulled on the dog.
As the disease progresses the dog can develop exercise intolerance, obvious
respiratory distress and gagging while eating or drinking.
Some dogs with tracheal collapse can turn blue when they are excited or stressed, and
certainly, secondary heart disease can result from the consistent straining to breathe.
Some dogs have both laryngeal paralysis and tracheal collapse, these dogs usually
make a wheezing sound when they breathe in. Trachea collapse can sometimes be
seen on a regular x-ray as a narrowing of the trachea lumen or opening.
Fluoroscopy which is a moving x-ray allows the vet to visualize the dog’s trachea as he
breathes in and out. An endoscopy allows the view of the inside of the trachea with a
tiny camera and really provides the best way of viewing the inside of the airway.
During the examination, the veterinarian can also take samples of the trachea for
culture and sensitivity or additional analysis. Sometimes an echocardiogram is
recommended to evaluate heart function.

13. Any disease of the upper or lower airway can be mistaken for tracheal collapse,
including the foreign body which can be a foreign object in the airway.
Laryngeal paralysis along with an elongated soft palate infection of the trachea lungs or
heart failure, as well as tumors or polyps. So it’s very important that you get a definitive
diagnosis and not just guess.
Conventional medical management of mild to moderate cases of tracheal collapse
involves the use of cough suppressants, antispasmodics, bronchodilators and sedatives
to help reduce coughing spasms and the associated anxiety.
It’s important to break the coughing cycle because coughing irritates the airway and
leads to more coughing. If an infection is present, of course, that has to be addressed
as well. And certainly, if the dog is overweight it’s really important that these dogs lose
weight.
I do recommend that you evaluate the dog’s environment because these environments
should be free of smoke and other environmental pollution.
All dogs with collapsing trachea should be walked only using a harness, I don’t
recommend anything around the neck as reducing any pressure at the level of the
throat is really important for these dogs.
Medical management works for about seventy percent of dogs with a mild form of this
particular condition. Holistic veterinarians do add in some cartilage builders to help
maintain the integrity of the tracheal cartilage.

14. Sometimes chiropractic and acupuncture have also been demonstrated to reduce the
intensity of the duration of these coughing episodes. In more severe cases, or for dogs
who don’t respond to medical management, sometimes surgery is recommended.
If the collapse is happening in the neck or the thoracic Inlet, plastic rings are placed
surgically around the outside of the trachea.
If the collapse is deeper in the chest, then oftentimes a stent is placed in the trachea.
The stent is basically a little tiny spring that holds the trachea open.
Repair of tracheal collapse is a very specialized surgical procedure, don’t let your
veterinarian will tell you that it’s no big thing.
These particular procedures have significant potential for complications, and so, it
should only be performed by a veterinary surgeon that has extensive knowledge in a
well-equipped hospital.
Hip Dysplasia
Hip dysplasia essentially is a deformity of the hip joint. It can lead to degeneration of the
joints, arthritis, inflammation, and pain. The vast majority of dogs get hip dysplasia,
likely as a result of an inherited factor.
And that’s combined with factors such as body weight, rate of growth, possibilities of
trauma during development, and other factors such as environment play a role in this.

15. We commonly see hip dysplasia in breeds such as golden retrievers, Labradors,
Rottweilers, and the German shepherd is probably the most common in our practice.
Most owners are going to recognize some type of discomfort. Often, reluctance to play
as a puppy, there going to see a change in the way the hind legs are being used.
Often smaller dogs like the Shih Tzu will bunny-hop using both hind legs together to get
around or especially going upstairs.
You may recognize pain when the dog first gets up after a period of rest, or they may
see early exhaustion compared to other dogs they’ve had experience within the past.
If owners feel that their dog is possibly suffering from hip dysplasia, the simplest, best
solution would be to see their local vet get first an examination, and then quite possibly,
x-rays to follow.
A veterinarian is going to examine a dog to determine if it has hip dysplasia. Some dogs
can be examined awake, however, often it’s useful to sedate the patient to determine
whether the hips are lax.
Laxity is the key finding in dogs with hip dysplasia. There is a test for laxity that we refer
to as the Ortolani sign.
In the Ortolani your vet will push on the femur under sedation, the femoral head rises
out of the joint, the femoral head is now subluxated, we lift the leg up, and it clicks back
in.

16. Were feeling for that click back in to tell us that the hip was actually out. If your vet
confirms this, this is hip dysplasia, regardless of what they see on an x-ray. As always, it
is best to discuss with your veterinarian the ideal treatment options for your pet.
Kidney Disease
Your pet’s kidneys are very important organs, they regulate your dog blood pressure,
blood volume, water consumption in the blood as well as pH levels.
The kidneys also produce a variety of hormones, including ureteral poo eating that
stimulates red blood cell production.
As blood flows through your pet’s kidneys, they filter out waste products generated from
the breakdown of food, old cells, and metabolic byproducts, toxins or poisons and many
drugs.
The wastes are removed when your dog urinates and so the kidneys also act as filters
to trap good substances, like proteins back in the body and the bloodstream. Kidneys
also help regulate calcium and vitamin D levels.
Chronic kidney disease, which is abbreviated as CKD in pets, is a kidney disease that
has been present for months to years.
It’s also called chronic renal disease, which is CRd or chronic renal failure which is
abbreviated as CRF. As well as chronic renal insufficiency so there are lots of names for
the same syndrome.

17. Dogs of any age can develop chronic kidney failure, but it’s more commonly seen in
older pets. Kidney failure often happens so gradually that by the time the symptoms
become obvious, it’s really too late to treat the problem effectively.
The kidneys actually find amazing ways to compensate as they slowly lose function
over a period of months to years, which is why obvious symptoms don’t often appear
until very late in the disease process.
There are many different causes of kidney disease, including congenital or at Birth
malformation of the kidneys, chronic bacterial infections of the kidneys, high blood
pressure, urinary blockage, and certain drugs.
An episode of acute kidney disease, for example, from a poisoning that permanently
damages your dog’s kidneys can lead to a chronic form of kidney disease. Many times
no cause can be found for dog kidney problems.
Symptoms Of Chronic Kidney Failure
Symptoms of chronic kidney failure typically occur gradually over a long period of time,
but they can include vomiting, lethargy, diarrhea or constipation, depression, gradual
but consistent weight loss, increased thirst, anorexia, acute blindness, seizures or
coma.
Blood in the urine decreases the frequency or amount of urine in some situations as
well.

18. Less common signs include oral ulcerations and bruising, weakness or pathologic bone
fractures that can result in animals breaking bones out of the blue.
There is also a weird symptom of itchy skin from calcium and phosphorus deposition in
the skin and GI ulcers are bleeding into the stomach or gut can also be a rare symptom.
Your veterinarian will need to run a complete blood profile that includes a chemical
blood profile, complete CBC and urinalysis.
Dogs with chronic renal failure may have anemia, abnormal electrolyte levels, abnormal
or elevated blood pressure and abnormally high levels of creatinine and BUN or blood
urea nitrogen.
One of the primary indicators of CKD is dilute urine, so on your analysis, the specific
gravity will be low which means the kidneys aren’t capable of recycling water normally.
Other tests may include x-rays or ultrasound imaging to check the size and shape of the
kidneys for obvious abnormalities, as small kidney size an ultrasound or x-ray is another
indicator of chronic kidney disease.
The severity of CKD can be estimated based on blood waste production levels, or
abnormalities in the urine such as the presence of protein. A method exists to estimate
the stages of CKD and the stages are numbered one through four, one is the least
severe, and four is the most severe.
The higher the stage number, typically the greater the symptoms that are seen, but
that’s not always the case. Occasionally, especially when the kidneys are enlarged

19. instead of abnormally small a kidney biopsy may be performed to look for a definitive
cause for why the kidneys are dysfunctioning.
If your dog’s kidney disease is caused by some factor other than damaged kidneys, for
example, a disease that decreases blood flow to the kidneys, or a urinary tract
obstruction, it’s possible the problem with the kidneys can be reversed with appropriate
treatment of the underlying disease process.
If kidney disease is a result of irreversible kidney damage, in many cases renal function
will stabilize for weeks or even months at a time. The disease will continue to progress
over time and kidney function will continue to deteriorate, but your pet symptoms can be
minimized with supportive treatment.
Kidney Failure Supportive Treatment
Fluid therapy is the cornerstone of treatment for animals with kidney failure, primarily to
prevent dehydration. Subcutaneous or under the skin fluid delivery will be necessary
and many pet owners can learn to do this at home so you can reduce stress in your pet
of having to bring them to the veterinarian.
Potassium is often added to the fluids or the animal’s diet to safeguard against muscle
weakness and heart rhythm disturbances, that can result from a low electrolyte level.
In some cases, IV fluids may also be necessary, your dog should have round-the-clock
access to fresh water and clean water.

20. Withholding water, for example overnight, will not solve your pets’ need to pee more in
the middle of the night and actually can cause terrible additional stress on your pet’s
kidneys.
You’ll need to keep careful track of the amount of food and water your pet consumes
each day if consumption decreases additional fluids may need to be administered with
an IV for disease management and overall well-being.
I advocate an organic fresh food diet for animals with kidney dysfunction. A reduced
amount of high-quality human gait grade protein is really essential, as is eliminating all
dry foods which actually can exacerbate your pet’s dehydration.
Feeding a high moisture reduced phosphorus diet is really essential, and an integrative
or holistic veterinarian is really your best resource for advice on all the right
supplements as well as medications if necessary.

21. Back problems (Intervertebral Disk Disease)
Intervertebral disk disease is a serious condition seen more often in dogs than cats.
Intervertebral disk is cushioning pads of fibrocartilage that sit between most of the
vertebra of the spinal column.
Intervertebral discs have an outer layer of tough fibrous tissue and a center that is more
of a gel-like substance.
These discs act as shock absorbers for the bones called vertebrae in the spinal column
and unfortunately, they are subject to degeneration bulging outward and even bursting
or rupturing.

22. When something goes wrong with a disc the material inside escapes into the spinal
column, pressing against the spinal cord earner of roots which causes pain, nerve
damage and sometimes even paralysis.
This is called Intervertebral disk disease or IVDD. Depending on the location of the
damaged disc problems can occur anywhere in the animal’s body from the neck to their
rear limbs.
In cats, the problem discs are more commonly found in the neck and the upper back, in
humans the condition is sometimes called a slipped disc or a herniated disc. It is one of
the most common ​neurological​ disorders seen in pets, especially dogs.
Most aging dogs have some degeneration of Intervertebral disks which commonly
results in a common condition known as spondylosis. Most of the time spondylosis
doesn’t cause pain or weakness and doesn’t progress to Intervertebral disk disease.
There are two forms of IVDD in dogs called Hanson type 1, and Hanson type 2.
Hanson type 1 is the acute explosive herniation of a disc, this type of IV DD is typically
seen in middle-aged dogs with breed-specific inherited skeletal deformities lurking in
their DNA.
These dogs include the dachshund, Shih Tzu, beagle, Pekinese, poodle, Corgi, basset
hound, and others with characteristics of genetic dwarfism.

23. Hanson type 2 IVDD involves a gradual progressive protrusion of disk material that
affects breeds who are older usually eight to ten years. In particular German
Shepherds, Labrador retrievers and Dobermans.
Obese and out-of-shape dogs are more predisposed to this particular syndrome and are
at higher risk of acquiring IVDD.
Back and neck problems are quite common in Shih Tzus, due to their relatively long
backs. Among them, intervertebral disk disease is probably the most frequent one.
Floating Kneecaps (Patellar Luxation)

24. Patellar luxation is most often seen in small and tiny dogs and actually the condition can
kind of sneak up on you. Oftentimes your dog seems just fine, no injury, there not
limping, there’s no pain and these dogs are usually very active.
They run and play normally, sometimes the only subtle sign that you can tell that your
pet may be dealing with this genetic defect is that your dog skips or hops on a walk.
So they’re walking along and then you see them pick up a back leg, and maybe hop for
a step or two, and then put it back down and be completely normal.
What usually happens is you have no idea that this genetic condition is going on. Your
dog is playing and then suddenly they cry out, pick up a back leg, holding it off the
ground, hops along and is clearly in distress, and they tend to put the leg back down
and keep walking like everything was fine.
It’s like acute lameness and then the whole issue goes away, which can be concerning.
Because the recovery is just as amazing as, and profound as the apparent injury was, it
can be confusing to pet owners where their dog is suddenly injured and then appears to
have this amazing recovery.
What you’ve just witnessed in these episodes is your dog’s kneecap pops out of its
groove or out of place, which causes him to stop in his tracks, holds up the leg, try and
relieve the discomfort, and in many of those instances the kneecaps pop back in place.
This condition is very common and oftentimes you have no idea if it’s happening until
there’s this acute episode.

25. What’s happening physiologically is your dog’s kneecaps sits like a pea in a pod, at the
same place in her leg that yours does, which is at the distal end or the far edge of the
femur or thighbone.
The patella helps the quadriceps muscles move smoothly across the joint between the
thigh and the lower leg, and the kneecap moves up and down in a wedge-shaped
groove right on the thigh bone.
The patellar ridges hold the kneecap in place and as long as the ridges are deep, then it
really means that the kneecap can sit beautifully. Kind of lodged where it needs to be
then there’s no issue.
In larger dogs, the kneecap tends to pop to the outside, called a lateral luxation, while in
smaller dogs the kneecap tends to pop to the inside or medial luxation.
The genetic predisposition for floating kneecaps occurs in many tiny dogs, like the Shih
Tzu.
They don’t have the genetic predisposition for this to occur, but because their femurs
are so short it can change the economics of the knee and your dogs can end up with
the luxating patella, even though they have a deep groove or patellar groove.
Large breed dogs actually have less of a genetic predisposition with kneecap issues
than smaller breed dogs. Large breed dogs typically have a nice deep groove for their
patella decision, however, some large breed dogs are prone to hip problems.

26. If there’s a problem with your large breed dogs hips it can eventually force the patella
out of its groove, so that can be a secondary luxating patella as well.
There are four levels of severity of Luxating patella.
Grade one is the mildest, grade four is the most severe. A grade one luxating patella
describes a kneecap that pops out or can be manually popped out by the veterinarian
and popped right back in on its own.
A grade two luxating patella describes a kneecap that pops out of place and doesn’t
always pop in automatically, which means sometimes the veterinarian has to push it
back in to recede it in its natural place.
A grade three luxating patella is when the kneecap sits outside of its groove, but it can
be pushed back into its normal place where it will stay temporarily.
A grade four luxating patella is the worst-case scenario, which means the kneecap sits
outside of the groove all the time, and even when the veterinarian tries to push it back in
it pops right back out, so it’s always seated in a very unnatural position.
It’s important to understand that a displaced kneecap can cause intense pain for your
dog, in fact in young dogs often with strong resilient joint and cartilage the patella can
pop in and out without obvious signs of pain.
Except that an original jolt when it moves out of its joint, as it pops across the ​patellae
Ridge, but then, of course, the pain doesn’t seem obvious and here’s why.

27. The femur and the kneecap are covered with cartilage, and cartilage doesn’t have a
nerve supply so the pain of the bone sitting in the incorrect position isn’t fully noted until
the cartilage is completely gone, and then when there’s nerve to nerve contact there’s
intense pain.
This can become the case where you have a young dog where you’ve noticed that
they’re intermittently limping, but they seem totally normal in between.
They’re not having constant pain because they still have some cartilage that’s protecting
those nerve endings, as that cartilage wears thin pain can become more notable and
more consistent.
In young dogs as the cartilage wears down from the frequent travel of a kneecap in and
out of its regular groove, which is basically the beginning of early arthritis, there will be
some bone to bone contact at some point early on in your dog’s life if they have a
significant kneecap luxation.
And obviously, the speed at which degeneration occurs depends on the size of your pet,
the severity of the luxation and the amount of use and abuse that those rear limbs take.
The more well-muscled your dog is the slower those changes tend to occur because
muscle tone holds your dog’s skeletal system including those kneecaps in place. You
can never underestimate amazing muscle tone for helping to slow down the progression
of this condition.

28. If your dog is diagnosed with even a mild grade one luxating patella, I recommend that
you address it right away.
The quicker you take a proactive approach to treating this condition, especially in young
dogs, the better your chances of avoiding surgery down the road as well as joint
degeneration or arthritis and a decreased quality of life.
Your Dog’s Body Weight
The first thing you should do for a dog that’s been diagnosed with a floating kneecap is
to help him achieve and maintain his ideal body weight. The heavier the dog the more
burden there will be on both of his knees, so if your dog tends to be a little bit
overweight diet him down to his ideal body weight.
Optimal body weight for your dog means a lot of lean muscles and a reduced amount of
fat, and keeping him lean is just less stress on the joints.
Your Dog’s Muscle Structure
Number two – It’s very important to maintain your dog’s motion, maintaining excellent
muscle tone will help give your dog’s body kind of a cage around that knee, that will
help stabilize the patella.
Years ago veterinarians advised dogs with floating kneecaps to not move, to keep still
and rest. And we know that’s a really bad idea because the muscle tone goes away and
the knee ligaments can become more relaxed, which can actually exacerbate the
condition.

29. The more toned the muscles of your dog’s legs, then the more stable the kneecap will
be.
Building muscle is a really important part of reducing the clinical symptoms of a luxating
patella. Muscle tone can’t be bought, which means no matter how many supplements
you put in your dog’s mouth, it doesn’t constitute a great muscle or a great body tone.
You must simply do the hard work which means daily aerobic heart-thumping exercise
to intentionally build muscle tone.
An hour of exercise is my recommendation and it doesn’t have to be a lot of jumping but
daily aerobic quadricep building muscle tone is really important.
If you can’t keep up or physically, or if your pet is too painful or obese to move then I
highly recommend you send your dog to a physical therapist or rehab therapist. They
can get your dog into an underwater treadmill to begin building that critical muscle tone
necessary to hold her kneecap in place.
Dog Supplements
The third thing I recommend you do is to provide your dog with oral joint support, in the
form of glycosaminoglycans or gags. Glycosaminoglycans or gaga are the raw building
bucks for cartilage repair and maintenance.

30. There are several different types of gags on the market, specific for veterinary use.
However, I typically use primarily human oral joint support supplements, to help
maintain the integrity of the knee cartilage while also improving joint fluid.
Those include sámi glucosamine, chondroitin, Poorna muscle, MSM and several
different natural anti-inflammatories which can help with pain including curcumin.
I also recommend that you discuss this subject of the luxating patella with your
integrative or proactive veterinarian.
They will be able to provide the right amount of supplements to rebuild and maintain
strong resilient cartilage, as well as appropriate joint fluid for your dog.
I also suggest that you talk about adequan with your veterinarian. Adequan is an
injectable gag which is injectable joint support that rapidly helps slow down premature
arthritis, but also builds a lot of great joint fluids, it does a great job of slowing arthritis
secondary to this condition.
Acupuncture
Chiropractic and acupuncture can also be very beneficial for dogs with luxating patellas,
in terms of reducing pain as well as wear and tear on the rest of the body.
If you have a puppy with this condition there are some really effective chiropractic
manipulations that can be performed to help the hips and knees be in good alignment,
which will also help reduce the progression of this disease.

31. I recommend that you start chiropractic care as soon as the diagnosis is made, I also
recommend that you feed a nutritionally balanced species-appropriate diet by feeding
your pet a naturally anti-inflammatory diet.
This means one that’s very low in carbohydrate content so you can actually help reduce
the amount of inflammation in your pet’s body.
Your Dog’s Diet
Feeding a species-appropriate carbohydrate-free diet can especially reduce
inflammation, so because carbs aren’t listed on your pet food label you are gonna have
to do that carbohydrate calculation.
You’re gonna have to grab a calculator and do that equation because I want to make
sure that you’re feeding your dogs less than 10 percent carbs if they have this
inflammatory musculoskeletal condition because the diet is a great way to help minimize
pain.
Many veterinarians often recommend surgery for any grade of luxating patella,
regardless of the severity of the condition.
Sadly I’m also here about people who have been told to do it, none of these above
suggestions but simply wait until the pain is crippling or the knee has degenerated to the
point that the dog is totally lame, and then make an appointment for surgical repair.

32. Surgery
I’m not a proponent of waiting and doing nothing, nor am I a fan of doing surgery unless
the condition is absolutely destroying your dog’s quality of life.
If your pup can’t run or walk without intense pain, or as having lameness associated
with a lot of decreased quality of life episodes, then absolutely you should consider
surgical correction but not before you’ve exhausted all of these non-surgical options.
My recommendation is to explore all possible non-surgical options to help stabilize your
dog’s knee before you consider surgical correction, but this should be done the minute
that you see your dog is skipping on a walk.
To protect yourself from the expensive vet bills associated with these conditions, you’ll
want to purchase pet insurance for your Shih Tzu before they show symptoms or are
diagnosed.