Calling all dog lovers -- Big vet bills and an ethically questionable surgery?
By ladyluna
@ladyluna (7004)
United States
January 19, 2008 6:50am CST
Our three year old dog Rollo has seen two different veterinarians in the last two weeks. He's had a number of x-rays, a chiropractic adjustment, and even canine acupuncture. And, what a good spirited trooper he has been! So far, the bills total about $750.00 and the estimated future surgical costs are estimated at between $4000.00 - $6000.00
The diagnosis is that he has torn crucit ligaments in his knee joints -- both knees injured at different times, though both fairly recently. The first vet discounted Rollo's joint issues. The second vet did a much more thorough exam, and found evidence of the torn ligaments. She has referred us to a Veterinary Orthopaedic surgeon, who is recommending either a TPA or TPLO surgery.
"'TPLO' stands for Tibial Plateau Leveling Osteotomy. This surgical procedure cuts off one of the bones of the dog's leg with an arc-shaped cut, rotates the bone through part of the arc, and re-attaches it at a different angle with a metal plate and screws. TPLO does not stabilize the stifle(knee). The idea is that changing the geometry of the leg will make stifle stability less important for joint function. "
http://home.earthlink.net/~tiggerpoz/id4.html
Now here's a respected professional opinion about TPLO and the possible complications. What would you do???
"... [In regard to TPLO there is a] virtual absence of research to show that this highly invasive and expensive method has any benefits whatsoever in post operative clinical function over other less invasive and expensive methods. I have taken a stand early in my career to avoid endorsing procedures that are not evidence-based ...and TPLO is a classic case of surgeons ... jumping on the bandwagon without adequate investigation to demonstrate the purported benefits of the procedure.
Sincerely, Gail"
[Gail Smith - Professor of Orthopedic Surgery; Chairman, Dept of Clinical Research, University of Pennsylvania Vet School]
The problems that can develop during and after a TPLO can be extremely serious. All surgeries have risk, but there are some especially nasty potential complications that are specific to TPLO surgery:
-- Cracking and splintering of the bones where the metal
plates are attached to bone with screws;
-- Persistent infections in the bones;
-- Failure of the patellar ligament due to increased stress
on that ligament caused by the altered geometry of the
joint.
-- Failure of the bone to knit back together.
-- Further damage to the joint menisci following
the 'meniscal-release' often done in association with
TPLOs.
-- Loosening of the metal plates caused by backing-out of
the screws after surgery or failure of the screws'
attachment from crumbling bone or other causes .
---Tibial tuberosity fracturing;
-- Spinal problems resulting from the altered bone
structure;
-- Increased cancer rates associated with the metal
implants.
-- And more.
4 responses
@janisspaggiari59 (656)
• United States
20 Jan 08
I would get another opinion from yet another vet.The first vet visit doesn't count too much because he didn't do a
complete exam.If you have exrays from the second vet then take the exrays to another vet and see what he would suggest.
If the second vet didn't take exrays then just give a new vet the information and see what this one says before you put your dog through all those risks of doing what the second vet suggested without getting a second opinion.
2 people like this
@ladyluna (7004)
• United States
20 Jan 08
Hello Janisspaggiari59,
You've given very sound advice here. At this point, my plan is to call the Morris Animal Foundation, the research wing of the Colorado Veterinary School, to pick their brains first about this type of injury, and the restorative options, first.
The problem with having more physical examination done is that each time a vet tests for ligament tears, there is a high incidence of exaccerbating the problem -- because they have to use a degree of force to feel for the 'floppiness' at the point where the femer connects to the knee joint.
Although you make a fine point about having another vet take a look at the x-rays, soft-tissue does not show up on x-ray -- only bone. There is a minor indicator in the bone that is common when a crucit ligament tear occurs, and it is visible on Rollo's films. So, I concur with your excellent suggestion. Thanks!
1 person likes this
@janisspaggiari59 (656)
• United States
20 Jan 08
Your welcome.You know most whats going on with the dog.I'm sure you'll figure out the best solution.
2 people like this
@redyellowblackdog (10629)
• United States
19 Jan 08
I did not notice whether or not you mentioned if the dog is crippled or in pain. So, I'll give a conditional answer. If the dog is greatly in pain or crippled badly, I'd consider amputation. I have seen dogs get around on three legs just fine. If the dog is not crippled or in pain, I'd skip this altogether.
This operation sounds like it will just be the beginning of a long line of expensive procedures.
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@redyellowblackdog (10629)
• United States
19 Jan 08
OOPs... you said both knees. Nevermind!
2 people like this
@ladyluna (7004)
• United States
19 Jan 08
Hello Red,
Rollo is not crippled, although he is in pain.
I have been giving him a homeopathic pain reliever called "Arnicaid" (great stuff for humans too!). It combines Arnica Montana with some other homeopathic soft tissue anti-inflamatory, and pain relieving meds.
He's also getting "Cox2Tame", which is a human-grade, dynamic plant derived anti-inflammatory & pain reliever, which I have used for years. Neither is at all narcotic, so it doesn't fool Rollo into believing that he doesn't have pain. This is good, as the complete absence of pain can cause further ligament tearing by him being too overactive.
Amputation might be an extreme option if it was only one of his back knees. However, it is both rear knees. Though you are 'right as rain' about three-legged canines having fulfilling, happy lives. We had to amputate one of our (now deceased) dog's legs due to bone cancer. He did very well on three legs.
You're also right about this TPLO surgery sounding like just the beginning of a very unpleasant scenario.
I'm heartened, though not yet confident, about a non-surgical option as outlined in this link: http://home.earthlink.net/~tiggerpoz/index.html
Suffice it to say, I have a great deal more research to conduct. In the meantime, we'll focus on limited mobility to facilitate his natural healing abilities. I don't believe that by doing so that we'll be doing wrong by Rollo, because his x-rays show that the first injury to his right knee, has recovered significantly.
The website that I've been studying is very uncomplimentary toward veterinarians who very frequently indicate that this highly invasive, risky surgery is always necessary. Though it does indicate that if after 6-8 weeks of limited mobility, if there is no marked improvement, that the dog is probably a candidate for the surgical option. We shall see.
1 person likes this
@drannhh (15219)
• United States
19 Jan 08
I vote with Gail, but it is difficult when one has to choose the solution for another, even another of a different species. One asks one's self what the dear doggie would choose. Good luck in making a decision you can live with. You are really in between a rock and a hard place on this one.
2 people like this
@ladyluna (7004)
• United States
19 Jan 08
Hello Drannhh,
Yup, this is a 'pickle' of a situation. Though, it's what we sign on for when we take these animals into our hearts & homes.
I'll contact the Morris Animal Research Foundation in Colorado on Monday to get the best veterinarian advice possible. Until we know for sure, I'm glad he's being such a trooper about all of this. He's acting like there's nothing wrong with a little pain -- he's such a stoic guy!
1 person likes this
@SixPaulEleven (552)
• United States
23 Jan 08
I was faced with a similar decision a while back about one of my horses needing drastic surgery to save her life. The vet reasoned with us about how she may or may not live and if she does, she can NEVER be ridden again. I took a chance, spent over $25,000 on her and she survived. She was in rehab and stall bound for a year, but she now runs with a slight limp.
All of those risks are just like the risks we take every day by taking medication or by undergoing surgery. There's a risk we may or may not wake up. There's a risk that additional surgeries might be needed. There's a risk of infection. There's a risk of the surgery not taking and that something else will need to be done.
I was told the same precautions about my horse's surgery -- risk of infection, risk of the surgery not holding, risk of permanent injury and so on.
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