Management plan:

Since we are a mixed animal practice in a rural area, we would refer the dog for any 
surgery.  But since our clients are not likely to opt for an expensive surgery, we must 
manage the case medically to minimize pain and discomfort of our patient.  NSAIDs 
should relieve the pain associated with inflammation.  We realize that past Rimadyl 
treatment has not been effective, so we recommend lifestyle modification as well to 
further reduce stress on the joint.  In order to reduce weight, we recommend restricted 
feeding of a canine maintenance diet and free choice water and discourage any mineral 
supplementation.  Exercise should be limited to leash walks, slow jogs, and avoid hard 
surfaces.  The dog needs enough exercise to prevent muscle atrophy, but limited enough 
to avoid further traumatic insult to the degenerating joint.  We will recheck the dog in one 
month unless lameness becomes more severe.