Is it always possible to get rid of lameness?

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I’m struggling with Gillie.  He has taken a quite large downturn this week.  We seem to have decent periods of relatively stable and then a sudden change.  I don’t know if this is a new bone fragment or something.
We saw the vet last week and she confirmed it is his elbow that is painful.
He is very painful and limping when he gets up from rest.  It hurts me to watch him so goodness only knows what it feels like.  After a stretch and a warm up there is little more than a tiny head nod when he walks and trots  We are now down to a few 10 minute on lead potters a day when in January he was doing 30 minute off lead with just Metacam every few days.  He is still playing with toys and eating and drinking quite happily.  We have made adjustments in the home, runners, rugs, raised food bowls, ramp up the step to the house.
He is 30kg and he is now on the full dose of Metacam, 250mg Paracetemol twice daily and 200mg Gabapentin twice daily.  He has physio and massage.  My vet isn’t happy for him to swim now due to the strain on the joint.
Should it be possible to get rid of the pain totally?  I know we can go up on the Gabapentin but the vet wants to monitor him on the Paracetamol first as it was only introduced last week.
He is having PRP on the 22nd, I just wonder what is possible.  I’m finding it hard to know what is acceptable and what isn’t.  I could never say he has had enough because in every other way he is his normal self.
I am going to the event at Sussex County Dog Training later this month so hope to understand better then but I’d love any thoughts on this?

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Hi Hannah thanks for the lengthy reply, I really appreciate your time!
He had a claw infection a couple of weeks ago and improved massively on the antibiotics to the point I was wondering if this had been grumbling for a while.  The crash happened about five days after finishing so I think there is some concern that either some infection remains or even has gone to the elbow.  I’m keen to see if antibiotics improve things again as I imagine a PRP injection into an infected joint would not be indicated.  I’ve been in touch with my vet today and she’s going to see him again on Monday to check the claw and have a chat about a/bs.  I guess if he improves again we know there is infection somewhere and the next step may be a tap and or X-ray.
He seems fine on Gabapentin, he’s still full of life and playful and really wants to run.  It’s literally just the lameness on getting up that is an issue.  He’s a good weight, varied between 30-32kg but doesn’t look fat at all.  He’s on so little it would be a miracle!  We don’t have stairs other than two into the house which has a ramp.  I don’t use a Kong, he has a raised feed bowl.

thanks again!  Hopefully see you on the 27th.

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elbows are such a big problem so you are not alone.
An acute flare can take easily a week to calm down and in that period just walking to toilet etc is fine – this is acute inflame so requires, rest, cold packing, etc… in humans we use the acronym RICE – raise ice compress and elevate, and in many many we should consider the same thought process for dogs.
During this time using anti inflam at the higher doses is totally correct – I have had some better responses to pardale over paracetemol – but speak with your vet.
If with this approach there is no improvement then we advise reinvestigate as the situation may have changed and that fits well with your plan for PRP –  they may take some jt fluid to check it is not septic and they may whizz off an xray to check there is nothing else like a fracture or dare I say a tumor – clinical pictures change because the disease you are dealing with may change.
I would imagine the physio is allowing the joint to settle  and just performing some light range of motions, maybe some laser? but concentrating attention on compensatory change around the rest of the body that is putting up with the limp- hugely important to ensure the coping structures are coping well!!!
hydrotherapists would argue the toss on both free swimming and treadmill in this case – I would imagine both would dramatically decrease the amount asked of the dog  during this flare and concentrate on the hydrostatic pressures of the water helping with pain relief during this time
care with gabapentin. it is not always a wonder drug and can leave them quiet and depressed and make you think they are worse than they are – holly can not tolerate it at all and I have tried a few times and learnt my lesson that it makes her miserable
limps are mechanical or pain,  and looking at the rest of your dogs behaviour will often clarify [which it is… ie low mood and quick to tire would indicate more pain

  1. is he his optimal BW? ie a BCS 4.5/9 – you would be able to feel his ribs clearly like the knuckles on your hand
  2. do you use KONGS to feed?
  3. is he still doing stairs of any kind?
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