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From the start of her life, things were just not going right for Gracie Mae. She was born with several serious medical conditions, notably the inability to control her urinary and sphincter muscles, leaving her incontinent of urine and feces, and sometimes constipated. In addition, she had bilateral luxating patellas. Luckily for her she was surrendered to rescue after the breeder decided she was unable to be bred, was sick, and may even be dying.

Alabama Boston Terrier Rescue (ABTR) took Gracie Mae in, and took her to some of the best specialty veterinarians in Alabama to determine what was happening with her and how to best treat her.

She had come to them constipated and they wanted to know how to keep that from happening again. After consultations with several vet specialists, it was discovered that Gracie Mae had a major problem: she could not control her urinary or sphincter muscles and had a lot of nerve damage.

This meant that she was unable to "know" when she had to urinate or defecate, and that she was also unable to control her urination and defecation. The cost of taking her to all the specialists was several thousand dollars. 

But this is only the beginning of several other serious medical concerns.

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Long-term quality of life for Gracie Mae was now very uncertain. Incontinence in dogs (or dogs with housebreaking problems for any reason) is one of the biggest reasons that people cite for giving their dogs up, abandoning them, rehoming them, and taking them to a shelter.

So this would be a difficult issue for the rescue to address when looking for a home for Gracie Mae. But ABTR does not give up on dogs and they were not going to give up on Gracie Mae.

 I was asked to take her in and keep her safe and healthy for as long as possible, despite her permanent incontinence of urine and feces. I agreed to take in this sweet girl who didn't ask for any of this to happen. She was the victim of poor breeding.

We began our adventure together by finding the best way to cover her back end. There are many choices for diapers for dogs: some people use child diapers, others use doggie diapers.

There are disposable diapers and reusable (washable) diapers. A big consideration is the fit of the diaper. Boston Terriers are relatively easy to fit for diapers but other dogs such as English Bulldogs are shaped differently and diapers don't stay up as well so suspenders may be needed. In terms of expense, reusable diapers are more expensive upfront, but they save money in the long run.

I decided to adopt Gracie knowing that her special needs would make it hard to place her; few people would willingly sign up to take on a dog that had to be diapered all the time like an infant for the next 13 or so years. I also felt Gracie would have other problems as she grew older which would mean costly medical bills and time put in for special care. Little did I know how right I was.

Boston's with luxating patellas

As Gracie got older, she started favoring her back-right leg. She was losing the use of her left leg and putting a strain on her right hip in order to compensate. She was diagnosed with luxating patellas (kneecaps) in both of her back legs. Luxating patellas are kneecaps that pop out of place. This condition is fairly common in Boston Terriers. According to, female dogs are one and one-half times more likely than male dogs to get this condition.

Luxating patellas often start to occur on a dog that appears fine and has no history of traumatic injury to the leg. The dog is usually very active – running and playing normally. Then out of the blue one day she starts limping. She picks up one of her back legs or yelps while holding the leg off the ground. These can be signs that the dog's kneecap has popped out of place.

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Gracie Mae a female Boston Terrier, not only did she have one bad knee cap, both of her knee caps are bad. How bad? Grade four! 

What does it mean to say that a kneecap popped out of place? describes it this way. "Patellar luxation occurs when the dog's kneecap (patella) is dislocated from its normal anatomic position in the groove of the thigh bone (femur).

When the kneecap is dislocated from the groove of the thigh bone, it can only be returned to its normal position once the quadriceps muscles in the hind legs of the animal relax and lengthen.

It is for this reason that most dogs with the condition will hold up their hind legs for a few minutes. The kneecap moves up and down in a groove. Patella ridges hold the kneecap in place, and as long as the ridges are deep, the kneecap can only move up and down as nature intended. Unfortunately, some dog breeds have a very flat patella ridge.

This means the kneecap doesn't seat snugly in the groove and it can pop out either medially, to the inside, or laterally, to the outside. Typically, in larger dogs, the kneecap pops laterally, while smaller dogs' kneecaps tend to pop to the inside. Luxating patellas are typically genetic malformations and may start occurring in dogs around 4 months old.

We tried giving Gracie glucosamine and Omega 3 fatty acid supplements daily. These supplements are good for joint and bone health. medialpatellaluxationfigABut her condition was very bad. She was given a grade IV on both patellas and surgery was recommended. She was only four years old. 

Luxating patellas are graded on the severity of the condition from I to IV or V, with IV or V being the worst. The vet does an exam, takes a medical history, and does x-rays to determine severity.

A grade IV luxating patella is permanently luxated (dislocated) and cannot be manually re-positioned. In other words, the kneecap sits outside the groove all the time instead of popping in and out. The quadriceps muscle group starts to shorten as a result of the dislocated patella, making it difficult to fully extend the dog's leg.

The dog usually transfers most of her weight to her front and moves with bunny hops while holding her back legs off the ground. Generally, if the patella is graded as a III or above, most vets will recommend surgery because if the dog continues to move around in this manner, she is at risk for further knee injuries such as anterior cruciate ligament tears (ACL tears). 

IMGa 0976I could not put the surgery off any longer because in addition to increasing the risk for ACL tears, the longer severe luxating patellas go untreated, the more arthritis sets in. Gracie's main vet advised us of the great need for surgery. After consulting with 3 other vets (one regular vet, a local surgeon who told us he was not set up nor comfortable in handling a grade IV luxating patella surgery, and a specialist in Birmingham, AL, who had been highly recommended), I spent another $2300!

 The recovery process for this type of surgery can be worse than the surgery itself. It requires the dog to be on total crate rest for 6-8 weeks, except for short, leashed bathroom breaks. This is always a problem for the dog owners who can't imagine how they are going to keep their dog confined to a crate for 2 months.

Orthopedic surgeons tell them they must do this or the surgery will have been for nothing. However, many people can't do it (won't do it?) and their dogs never completely heal from the surgery. So I was facing the same dilemma: Gracie was a young Boston Terrier who wouldn't be allowed to play or romp or "use" her leg for 6-8 weeks. 


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Thankfully (and this is the only time I can say this!), Gracie wears diapers and did not need bathroom breaks outside. Instead, she was allowed to take brief walks around the house (she still had to be leashed lest she make a dash and start twirling like she does when she wants to play).




Recovery and Healing Instructions

While there is nothing you can do to prevent luxating patellas totally in a dog that has a genetic malformation, there are some things you can do to lessen the impact of the condition on the dog's overall health.

  1. Make sure your dog is at a healthy body weight. If your dog is overweight, put him on a diet in accordance with the vet. Once your dog loses the weight, maintain him at the healthy weight. This will lessen the burden on his knees.
  1. Keep your pet moving with regular exercise. Maintaining excellent muscle tone will help your dog's body form a kind of cage around the knee which will keep the patella in place.
  1. Spay or neuter your dog. The breeding of dogs with luxating patellas is highly discouraged because it is a genetically inherited condition. 
  1. Several human oral joint support supplements can help maintain the integrity of knee cartilage while also improving joint fluid production. Glucosamine and chondroitin as well as Omega 3 Fatty Acid supplement can be very helpful if the condition isn't too severe.
  1. Surgery can be a very effective intervention, correcting both the affected structures and the movement of the patella. In 90% of cases, surgery can free the dog from lameness and dysfunction.

There are 3 types of surgery that can be done to correct the luxated patella. The type performed on your dog depends on specifics of the dog's condition as well as the surgeon performing the surgery.

  1. The groove at the base of the femur may be surgically deepened to better contain the knee cap. This procedure is known as a trochlear modification.
  1. The knee cap itself may be "tied down" laterally (on the outside) to prevent it from deviating medially (toward the inside). This is called a lateral imbrication.
  1. The bony protuberance at the site of the attachment of the quadriceps tendon on the tibia may be cut off and then re-attached in a more lateral position. This is termed a tibial crest transposition. 


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We just received great news. 

After getting her left back leg's kneecap stabilized, Gracie Mae will not need a surgery on her second leg's kneecap for a while.   Here is the dilemma, Gracie's other kneecap is still a class four. 

In the future a surgery to correct the 2nd kneecap may be needed. Both her veterinarian and I feel she is mobile enough and without signs of pain. I will just keep the money saved for her set aside so in the future if the kneecap becomes a quality of life issue we could move forward and get the surgery done.


Gracie Mae is a diaper dog for life.
First Edit by Julie Bradford
Final edit by Lisa Kongsvik Keith
Formatted for publication  by Jan Mitchell