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Help me decide what to do about my hurt dog


UncleEJ
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I need help deciding what to do about my injured dog. She is an eleven year old Akita when a torn Cruciate ligament (comparable to a torn ACL in humans) in a rear leg. We noticed the injury last week after she went in for a dental and became lame on that leg the following day. I took her back and the vet did X-Rays, which showed calcification on her knee. He also preformed what they call the "drawer test" and her knee slipped, which indicated, at least, a partial tear. He sent me home with anti-inflammitories and tramadol. He explained to me the surgery he could do for her, and sounded like the results were usually really good. We went home to decide what to do.

 

Although the surgery is expensive, we can afford it, and I was ready to just go ahead and do it. Then, over the course of the weekend, she started to improve a lot. She is baring more weight each day and her activity level is increasing a bit. So I've decided to hold off, but I am very torn about whether this is the right thing to do.

 

Most importantly, I do not want her to be in pain. But based on some research I've been doing, this surgery is often not that successful.

 

I've read a lot about more conservative treatments but most of what I've read say that if the dog is over about 50lbs (she weighs 96lbs) surgery is amost always nessecary. From what I understand, if we don't surgically fix this, she will always be, at least somewhat, lame. And painful. And will develop arthritis in that knee.

 

She is old. The average lifespan of Akitas is 10-12 years. She is 11. Part of me thinks that if I don't fix her knee, she will decline faster due to pain and limited mobility. At the same time, the surgery could take a lot out of her at this age. She might not recover well. And it is expensive for a dog who may be near the end of life. But she is otherwise very healthy. Her teeth were just cleaned and are in great shape, she seems to see and hear just fine. She is active and playful and isn't even going grey in the muzzle! Her blood work before her dental was perfectly normal.

 

I am so torn and I just want to do the right thing for her. She's my first baby :)

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A tough question.

 

The fact she is bearing weight on the knee could just be the effect of the anti-inflammatories. She probably cannot be on those indefinitely. You could try Rutin or Turmeric supplements and sneak them into her food. They have anti-inflammatory benefits without the side effects.

 

1. Is the vet going to be the surgeon as well?

If so, what can he tell you about the surgery success rate for a dog her size and age?

Do you trust his judgment or does it seem he has an eye toward the potential profit to be made?

 

2. Do you think a second opinion is needed? Perhaps ask if anesthesia would be overly stressful on her given her age.

 

 

I think these are the questions I would want to answer before I go ahead.

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That is a tough one. Does your regular vet do TPLOs? If not, I would set up an apt with a boarded recommended surgeon in your area who does a lot of cruciate ligament repair. The bigger the dog, the more likely surgery will fail if using a lateral imbrication method. The consult with a reputable surgeon is worth it. These guys do and see so many of these cases they have a great feel for what may work best for your dog.

Best wishes!

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When it happened to our 26 lb Klee Kai, the vet told us that dogs under 30lbs usually heal on their own, while dogs over 30 lbs. need the surgery. Ours walked on 3 legs for about 8 months. Then one day it was if she magically healed and we cannot tell. My neighbor, on the other hand, elected surgery on his 10lb dog who was walking fine in about 2 weeks.

 

These are major injuries for dogs. If your dog is already improving, I would wonder about a misdiagnosis. Can you get a second opinion?

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I agree with getting a second opinion, especially from a veterinary surgeon.

 

As far as anti-inflammatories -- yes, she can stay on one of those for the rest of her life.  Many elderly dogs are on an NSAID for the last few years of their lives due to arthritis.  There are risks, of course.  Mainly GI, kidney and liver issues.  For my pets I've always believed the increased quality of life is worth the risks.

 

I think whatever I chose I'd want to have her on a good joint supplement and fish oil at this point.

 

FWIW, I don't think there's any one "right" answer here.  I know that makes it even harder. :grouphug:

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A tough question.

 

The fact she is bearing weight on the knee could just be the effect of the anti-inflammatories. She probably cannot be on those indefinitely. You could try Rutin or Turmeric supplements and sneak them into her food. They have anti-inflammatory benefits without the side effects.

 

1. Is the vet going to be the surgeon as well?

If so, what can he tell you about the surgery success rate for a dog her size and age?

Do you trust his judgment or does it seem he has an eye toward the potential profit to be made?

 

2. Do you think a second opinion is needed? Perhaps ask if anesthesia would be overly stressful on her given her age.

 

Yes, the vet is also the surgeon. I do trust him, he seems to be more concerned with her than the profit. We talked about the fact that she is old and I might not choose to do the surgery. He didn't seem to be judgmental about that. I hadn't really thought about a second opinion, but that is a good idea. I will give it some thought. The vet I go to is well respected in my area, so I will have to look into other good ones.

 

 

I think these are the questions I would want to answer before I go ahead.

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That is a tough one. Does your regular vet do TPLOs? If not, I would set up an apt with a boarded recommended surgeon in your area who does a lot of cruciate ligament repair. The bigger the dog, the more likely surgery will fail if using a lateral imbrication method. The consult with a reputable surgeon is worth it. These guys do and see so many of these cases they have a great feel for what may work best for your dog.

Best wishes!

Is TPLO where they break and stabilize the bone? That isn't what he likes to do. He explained the surgery he does as such: he goes in and moves a strip of muscle and uses it to replace / stabilize. He claims great results with this. But I need to go back and talk with him more.

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Absolutely have a board certified orthopedic surgeon evaluate your dog. I am the wife of a general practice vet, so I am very supportive of GP vets . . . but, I also know that *some* procedures are best left to the specialists. Large dog cruciate surgery is one of those. (Dh wouldn't touch it; not even on our own dog). Ask for a referral to a *board certified specialist* and get it evaluated there. Do *not* have your GP vet do the surgery. 

 

(((hugs))) Get the specialist's opinion on what is going on, and IF surgery is needed. The fact that he's doing so much better muddies the waters, so you want a clear understanding of options. Then, yes, if the money isn't an issue, do the surgery. 

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I would look up all things you can about helping her to heal naturally, if my dog.  At least before even considering surgery.   I had a dog with that and did not realize in time that dogs can and do heal from it at least sometimes on their own, until other people we know with a dog with this problem helped their dog through it naturally.  Surgeons tend to think toward surgery.  Post-op for this can be really, really rough.

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Is TPLO where they break and stabilize the bone? That isn't what he likes to do. He explained the surgery he does as such: he goes in and moves a strip of muscle and uses it to replace / stabilize. He claims great results with this. But I need to go back and talk with him more.

Tibial Plateau Leveling Osteotomy- they cut the proximal end of the tibia and rotate it until it's level, and then use a plate and screws to anchor bone in place. Since this surgery was invented in the mid 90's, it has rapidly replaced all forms of intra and extra capsular repair as superior for large dogs. I worked with surgeons in the time they transitioned to this technique. The recovery time, and return to function is remarkably better. I am familiar with the technique you are talking about, and I would not recommend it for large dogs. It has a potential to break down just like using a suture as a lateral imbrication does. It sounds less invasive than the TPLO, but recovery from what I have seen is slower. There are GPs trained to do TPLO's, but it does take specialized training and excellent surgical skills and specialized equipment, so most GPs don't do them. So of course they prefer any method that they can do. The surgeon is a huge factor in your outcome. In general this is easily their most commonly performed surgery.... They do TONS of knees. A GP would most likely not. If money was a factor than this is a different conversation.

 

I would highly recommend you consult with a surgeon (acvs boarded). There are so many factors here, including possible misdiagnosis (although not highly likely), that a surgeon's opinion would really help you weigh the pros and cons.

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I would look up all things you can about helping her to heal naturally, if my dog. At least before even considering surgery. I had a dog with that and did not realize in time that dogs can and do heal from it at least sometimes on their own, until other people we know with a dog with this problem helped their dog through it naturally. Surgeons tend to think toward surgery. Post-op for this can be really, really rough.

And a good surgeon can help you here too.. A good surgeon wants a successful outcome and will not push you towards surgery, if not the right thing for your dog. They are familiar with all kinds of therapeutic modalities, like water therapy, laser therapy, weight loss, supplements, etc. Just to clarify, a ligament never heals, and instability of a joint means pain. After a year, their own body creates scar tissue and arthritis to stabilize the joint... This equates to less pain temporarily but significantly reduced function, and early arthritis. In an old dog, there are many factors to weigh... A good surgeon will help you make the best decision for your dog.

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I second the recommendations have your dog evaluated by a Board Certified Orthopedic Surgeon.  Our 80 lb dog had TTA (tibial tuberosity advancement) surgery on both legs (about 1 year apart).  There is a WORLD of difference between the information we received from our regular vet, and the information the orthopedic surgeon was able to provide.  

Also - there is a yahoo group called 'orthodogs' that has a lot of great information.   I suggest signing up on that, and then posting your situation there to get feedback.   There are people who have older, large breed dogs in the same situation as you, and will be able to help you identify the pros and cons.   There are also people that have used approaches other than surgery, and it is helpful to get information about all of your options - particularly given your dog's age.

 

Good luck to you and your dog -  it is a tough situation!   

 

 

 

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I would proceed cautiously at this point. You mentioned that your Akita only started showing signs of injury after having Vetinary procedures which might have exacerbated underlying problems. If she appears "on the mend" I'd wait.

 

This is big and very expensive surgery. For a dog at the end of its natural lifespan does it make sense to have surgery?

 

I know these are anguishing decisions to make. All the best.

 

Bill

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My dd has a dog who had the ACL repair surgery on one leg last year.  Her recovery went very, very well.  Unfortunately, the other leg tore a few months ago.  My dd just cannot afford to have it fixed, much as she would like to have it done.  It has affected the dog's quality of life - can't hike or skijor any more.  However, she is still a happy dog, and as long as she doesn't overdo it, does not seem to be in pain.

 

Anne

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My sister and cousin both had dogs who supposedly had this injury.  When they got second opinions, one was told that wasn't the problem, and the other that it was not bad enough to need surgery.

 

My observation with my own dogs has been, I am sorry to say, that I have to constantly second-guess the reccomendations of the vets.  Not only are they often needlessly expensive, they can cause more problems than they solve.

 

ETA - also, I simply would not consider putting a dog that age under for surgery.

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Absolutely have a board certified orthopedic surgeon evaluate your dog. I am the wife of a general practice vet, so I am very supportive of GP vets . . . but, I also know that *some* procedures are best left to the specialists. Large dog cruciate surgery is one of those. (Dh wouldn't touch it; not even on our own dog). Ask for a referral to a *board certified specialist* and get it evaluated there. Do *not* have your GP vet do the surgery.

 

(((hugs))) Get the specialist's opinion on what is going on, and IF surgery is needed. The fact that he's doing so much better muddies the waters, so you want a clear understanding of options. Then, yes, if the money isn't an issue, do the surgery.

I will definitely look for a specialist. Hopefully there is one in my area.

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I would proceed cautiously at this point. You mentioned that your Akita only started showing signs of injury after having Vetinary procedures which might have exacerbated underlying problems. If she appears "on the mend" I'd wait.

 

This is big and very expensive surgery. For a dog at the end of its natural lifespan does it make sense to have surgery?

 

I know these are anguishing decisions to make. All the best.

 

Bill

Yes, I am pretty confident that her injury was aggravated by her dental cleaning procedure. Which makes me feel even worse, I was trying to something good for her, something to hopefully prolong her years, and now this. :(

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It's hard. My old doggie needs a dental cleaning, but when she was evaluated for sedation etc., they found a couple of tumors. She is already at the end of her life expectancy, and doing well.  No pain or problems yet, and I will certainly take whatever pain management measures we need to in the future.  But together with the vet, we decided to not have the dental procedure, or surgery.  A 15 year old dog is a 15 year old dog. Keeping her happy and pain free is our goal.

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We had a 115 Newfie/black lab mix that this happened to.  By the time we could get in to the specialist he had pretty much figured out how to walk pretty well with it. He was a good old boy too.  Our vet said to keep an eye on him but felt we could manage him with medication as needed and that is what we did. If things would have deteriorated we would have gone ahead and done the surgery but he was getting along pretty well without it. We kept a good eye on him to make sure he wasn't in pain. He managed to have a couple more years in him and did fine. He was on anti-inflammatories the last year.  With the age of your dog I think I would take a wait and see attitude. That is a pretty big surgery to put a dog that age through.

 

It is always hard to decide what is best for our furry friends especially when they are senior citizens. 

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