Question for dog-owners - cruciate ligament sugery?

[bikerz]

Hi all - I know many of you out there have dogs, and I'm hoping at least a few of you have some experience that can help me and my pup Simon.

I found out last week that Simon (some of the NorCal people have met him) has a totally ruptured cruciate ligament which requires surgery. There are apparently two types of procedures: one that sort of re-creates the ligament out of other structures, and another, called TPLO, that actually changes the angle of the tibia and femur, and attaches a metal implant. The latter procedure is generally twice the cost of the first (about $4,000 :eek: compared to under $2000) and is recommended for larger, more active dogs. Simon is medium-sized, medium activity pit-mix. Since it is probable that the ligament in the other leg will fail at some point too, I'm really hoping that the less expensive (and extensive) treatment will suffice.

I've called around to the local vet surgery places here in the SF Bay Area, and I can get some general info, but for a more detailed consultation, I need to have a regular visit for $100+, and if I go to each one, that's really going to add up.

Have any of you out there had to have either of these procedures done for your dog? If so, do you have any helpful advice?

Thanks!

And so you can put a face with a name, here he is, in all his sweetness:
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[LBTC]

Simon's a cutie! I'm sorry I can't help you with your decision, luckily our babies have not had this problem yet.

Have you done some google searching online? We found lots of information about other health conditions our "kids" have been through that way.

Good luck! And give Simon a big scratch behind the ears and a cuddle from all of the critters, me and DH.

Hugs and butterflies,
~T~

[KnottedYet]

My mom's dog had the $2,000 version, and it failed. The doc had to go back in and do it again. It failed, too.

She's an older dog, and my mom didn't want to put her through surgery again. Now the dog limps, but seems comfortable.

[snapdragen]

What a face!!!

I'm no help either, only serious thing Chloe's had were the corneal ulcers.

This is where she went: http://sbvs.com/

They have ortho vet's there too. Maybe give them a call?

[yellow]

Oh, Z! I'm so sorry for Simon!

We have some friends whose lab had BOTH rear legs done, the re-creation route (and he was a big boy, probably 90 lbs). He had his first one done and the vet predicted that the other leg would need to be done within a year...sho' nuf. Seems that all the favoring of the first-injured leg can often lead to the other leg getting the same type of injury.

He gets around fine now and both surgeries were very successful. If you do more consultation, make sure you ask about how it will affect the rest of the dog.

Sammy & Pika (http://i24.photobucket.com/albums/c1/tasdan/Just%20for%20Fun/DogsDec06007.jpg) send doggie luv Simon's way.

[trickytiger]

My 100-lb (NOT fat, just big!) golden retriever had the less-expensive procedure done on one hind leg when he was six- the surgery was a success, and he had another good 6 years of life. It was crucial that we caught the problem early, though, and he didn't have any other complications.

Good luck!

[Xrayted]

My dog Cheyenne, a petite Siberian Husky at 50lbs, ended up having both hind legs done. The first one I think she was around 4 y.o. I noticed she was favoring it and took her to the vet right away. He yanked and pulled on her and told me that she was out of shape and to take her for more walks. (I walked her twice everyday except when I noticed she had a limp) So, I took her out for one that night and she tore it completely out. I carried her the whole way home. It happened right before x-mas and the surgery was around $500. I did the first choice you mentioned. Yes, she ended up loosening up the second leg one year later (also as a x-mas gift) because she favored the one leg for a long time. She lived to be 11y.o. and toward the very end, had some arthritis in the knees and hips. But, who doesn't at 77y.o.?

In the end, it's your dog and you will know what is best for him. Good luck.

[divingbiker]

My cocker, Remy, had the first type of surgery on one of his rear legs about 6 years ago now. He's fine now, and the leg is as strong as the uninjured one. He's 13 and has terrible arthritis in his hips, for which he has regular acupuncture treatments, but the knee is good.

One thing about the recovery--for several weeks, the dog can not walk up/down steps or walk much at all, and must be crated most of the time. That's fine when your dog is like Remy, about 35 pounds, but I know people with larger dogs who had a very difficult time carrying the dog down the steps to go outside. I built a ramp on my front steps but it was too steep and Remy wouldn't use it. Also, Remy would sneak around and jump up on the couch when I wasn't watching and his recovery went slowly, so we went to a dog swimming pool (one of the advantages of living in a city--we've got access to EVERYTHING) a couple times a week for a month or so and that strengthened his leg.

Good luck!

[Bad JuJu]

Poor Simon! He's such a good-lookin' guy!

My black lab/chow mix, Solita, had the less expensive surgery for her ACL injury. She was smallish for a lab--a little over 50 pounds, but extremely active. We live on a bayshore, and she spent most days running and swimming. We had the surgery done by a vet from the Auburn University vet school, and it was successful. She continued to limp just a bit for the remaining 5 years of her life, but she remained active and never had to have another surgery.

The hardest part was the recovery, as divingbiker mentioned, which involved lots of carrying and keeping her restrained. That was miserable, mostly for poor Solita, but totally worth it.

[Xrayted]

Simon really is a great looking dog. Such a kissable little face there. :D
Yeah, like divingbiker said, the recovery is long and hard on both of you. I carried my dog around for quite a while and would stand out there with her and hold the leg up so she could do her thing. The pityful looks I used to get from her would break my heart. (don't let the other dogs see me like this kinda looks :o) I also built a ramp for her off the deck next to the steps and she actually liked to use it. I left it there so that she didn't rip those knees out again. I put grip strips on it too so she had better traction when it was wet out.
It was much harder on her than it was on me but she recovered very well and could run and jump almost as well as before the surgeries.

Good luck. Keep us posted.

[anakiwa]

I have a 65 lb 5 year old lab who had both knees fixed in October.

Her trouble started last spring. I really wanted to try conservative measures first- we tried aspirin, glucosamine, rimadyl (a great pain med by the way, but it still wasn't enough). It started with just her left, then the other one was bothering her as well. She's normally a really active dog (runs, cross-country skis, hikes with me). By the end of the summer she was clearly really uncomfortable most of the time. By the time I wound up seeing the the orthopedic surgeon I knew it was the right thing to do to have it operated on.

My operative report says 'fibular head transposition secured with a screw and spiked washer'. I suspect that it's the first surgery that you're talking about. Total cost to do both knees was $2200 (this was the low end of the estimate they gave me, everything went smoothly and she only needed one night at the vet).

We're now at the 3-4 month point and I'm really happy with the results. She's not normal yet (not sure if she'll get there or not), but she continues to get better all the time. She was really uncomfortable the first night I brought her home, but after that she did fine. I had her doing short runs 2 months later, and she's able to cross-country ski with me now. The biggest difference is that she's clearly not in the pain that she was in before having surgery. She's a pretty active dog (and not overweight) and that probably helped with the recovery. There's no doubt that it was the right thing for my dog (and again it took me a while to admit to myself that she needed surgery).

Good luck with whatever you decide to do!

[maillotpois]

Nothing helpful to say except - I LOVE SIMON!! What a great face!!

[bikerz]

Thank you everyone for all your stories and advice. Yes, my little buddy is a great dog, and such a trooper!

Simon weighs about 55 pounds, and I can pick him up and carry him moderate distances (I've done that a few times over the last week when he seems like he's having trouble with stairs). I am a little concerned about the recovery, but my roommate's dog (who has since passed away) had very poor mobility, and we had ramps for her off the deck into the "elimination area", so luckily those are still around and can be pressed into service for Simon.

I'm going to call a few other places tomorrow for estimates on the non-TPLO, since so many of you have had (or know of) good results with it, and then get the procedure scheduled as soon as possible. I don't want to leave it too long, but I have to be back east for a week in 2 weeks, so I may have to schedule it for after that if I can't line up some good puppycare for him when I'm gone. Luckily, Simon has a huge fan club!

And because I can't resist, if you thought that other photo of him was kissable, how about this one? (For those of you who can't read pitbull lips, he's saying "wooo wooo") :D
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[chickwhorips]

good luck with everything. i have no advice to offer, but that face just gets me!

peanut says she would like to be his friend. :)

[KnottedYet]

Oh, he is so GORGEOUS!!!

[crazycanuck]

What a cute doggieeeeeee :D

Give him a big hug from me. Wroooof Wroooof :)

C

[sbctwin]

He looks like he is singing in the choir...so adorable, and yes, kissable...I hope all goes ok....

[Bad JuJu]

Woo-Woo to you too, Simon, and good luck with your surgery!:)

[SadieKate]

BZ, I'm so sorry to hear the news. Simon is such a good buddy, always full of happy wiggles. Give him a hug from me.

[xeney]

If you are not one hundred percent sure which way to go, since you are in the Bay Area, my advice is to set up a consult at UC Davis (you might need a referral for orthopedics) and find out which surgery they recommend. I love UC Davis. We have a regular local vet, but we have been referred to them three times, once for each of our dogs, and every time their advice has been reasonable and conservative, and we have felt entirely comfortable following their suggestions.

Our oldest dog has hip dysplasia, and our vet referred us to UCD for a hip replacement. UCD talked us out of it because they didn't think it was necessary in his case. It is now seven years later, and nobody who hadn't seen his x-rays would know he had anything wrong with him. It was $250 for the consult and all the testing.

More recently (like, yesterday) our little dog, the one in my avatar, went to UC Davis for an MRI after a very expensive neurologist told us he probably had brain cancer. She spent a thousand bucks of our money getting us to that point, but UC Davis took a more conservative approach, redid a lot of the testing, and suggested that his problems might just be side effects due to a recent change in his epilepsy meds. (He's been epileptic all his life.) We still don't know if that was the right choice, but we feel pretty good about taking their advice; they were upfront about the risks of every option and the prognosis for every outcome, and instead of rushing us into an expensive and unpleasant MRI and a spinal tap, they charged us $100 for a thorough exam and a frank opinion.

I am a big fan of UC Davis. I always feel like they tell it to you straight and do not try to sell you on procedures just to make a buck, and they always keep the best interest of the animal in mind, and they are honest even when you don't want to hear it.

Incidentally, that dog is about 40 pounds and seven years old, and he blew out his ACL (anterior cruciate ligament) on one of his rear legs when he was a year old. Our vet said that because he was a relatively small dog, he wouldn't advise putting him through either surgery, because the leg muscles would probably be able to compensate for the ligament. The leg healed quite well, and while he occasionally runs on three legs when it's wet or cold out, he doesn't even limp and I have never seen that leg slow him down. 50 pounds was our vet's cut-off, though; if he'd been heavier we'd have had the surgery. And we have always made a point of keeping him lean to keep the stress off that knee. (My husband had had ACL surgery two years before and he really didn't want to put a dog through that.)

Good luck to you and your dog.

[Wahine]

OMG, Simon is so cute!! I just want to scrunch up his lips and kiss his face and say woooo hooo right back. What a sweetie.

Good luck Simon!!

[bikerz]

Xeney - thank you very much for you advice about UCD - I will look into it because I am getting conflicting advice from the vey places - the ones that specialize in TPLO are (of course) recommending that. The place I was referred to for the suture process, which is not certified (or whatever it takes) for the TPLO of course says the suture process is better. Ugh. And I don't have time to go to vet school so I can make my own decision!

So it look slike a day off work and a trip to UCD might be in order this week - just to get a what might be a more neutral opinion.

And Simon say thanks for the good wishes! The sore leg hasn't slowed his happy wiggling down at all!

[SadieKate]

Xeney's story reminded me of our own experiences with UCD. Izaak presented with epilepsy as a 4 mos old puppy and we took him there a couple of times in the middle of the night, that being when grand mals frequently occur. One time, he obligingly had one right there in the clinic proving that mom and dad weren't over-exaggerating his symptoms. Anyway, we discussed a MRI but asked if the results would change the treatment plan. The answer was no change as we had just started phenobarbital so had had no time to get the dosage stabilized. The MRI might provide some answers as to the cause of the epilepsy (which was very new to the standard poodle breed at the time) but wouldn't change the treatment. The vet was very supportive of our decision to wait. Back then a doggy MRI would have been a couple of thousand dollars, and we didn't see how it would change Izaak's quality of life at the time.

Guess the point of this story is that the UCD vets were very reasonable in considering all the options and benefits without pushing revenue into the system.

Our regular vet (Joan Teitler) sold her practice so she could work there. One of the most intuitive vets I've ever met. Amazing the diagnoses she comes to just seeing the dog walk in the door, and the best follow-up of any doc I've ever met, for hoomans or aminals.

[aka_kim]

Z - if you can't make it out to Davis, I've had really good experiences with the Veterinary Surgical Associates/Veterinary Medical Specialists in Concord and the Berkeley Dog & Cat Hospital.

Hope Simon feels better soon. He curled up on the sofa with me that time I wasn't feeling well enough to do the Oakland Hills ride. He's such a sweetie!

[xeney]

Joan was my vet, as well, when I still lived in Davis. She is wonderful. We are very lucky to have found a vet in Sacramento whom we like just as much, but I'm glad to know she is still practicing.

[Trek420]

Z, give Simon lots of ear scratches and a big ol' bone for me.

Simon is not only one of the best behaved pits I've ever seen, he's one of the nicest dogs I've met.

[Duck on Wheels]

The latest news here about ruptured ligaments is that there's some kind of drug, injected as a gel into the joint? -- I'm vague on the details though it's only a couple weeks since I read about it, but anyways ... the received wisdom that a ruptured ligament will not regrow has been disproven. Ruptured ligaments do regrow, but there's some kind of process within the joint that disolves them as they do, so the trick is to stop that process.

[Dogmama]

The success of the surgery depends, on large part, the skill of the surgeon. I agree that UCD would be your best bet.

I had a German Shepherd who had the less expensive surgery - primarily because the expensive surgery had not been invented yet. The ortho was excellent and the leg turned out beautifully.

I would spend a few extra $$ on a good surgeon & go with whatever UCD recommends.

[bikerz]

Thanks again everyone for sharing your advice and experiences. I was out of town all last week at a conference, so am only now getting an update posted.

Simon had the "less expensive" surgery Saturday from a vet that a friend recommended. The vet who did it has done literally thousands of these procedures (interestingly, many of them were on pitbulls) and he has a very good track record, and was very freindly and informative when we spoke.

Simon also had a suspicious tumor removed from his right foreleg - the biopsy results on that lump will be in on Friday - I'm trying not to think (i.e. worry) about it until then.

Simon came home Sunday afternoon and is recovering now - it seems to be going OK, but I don't really have anything to compare it to. He can totter around pretty well on the 2.5 good legs he's got, but I'm trying to keep him settled. He has 2 different pain meds, antibiotics, and a sedative to help keep him calm.

I keep telling him he'll feel better in a few weeks, but I'm not sure that message is making much of an impact! I'd post a picture but he looks so pathetic I can't bear it! I'm definitely getting a good workout carrying him (all 48 pounds!) in and out of the house to do his thing.

He's sleeping next to me now, all bundled up in a blanket to keep warm. Poor pup!

[chickwhorips]

glad to hear he's home and recovering.

good doggie healing vibes coming your way.

[LBTC]

hugs and dog friendly butterflies for you and Simon,
~T~

[snapdragen]

Awww, poor Simon! Give him an ear scratch from Chloe and me, hope he's up and about soon.

[bikerz]

Thanks everyone for your good wishes (and Simon says "Thanks" too).

He's doing much better, but the trick is to really keep him calm so he doesn't jump up suddenly and hurt himself - last night's earthquake caught us both by surprise, but I don't think he injured himself when he reacted.

The tumor on his front leg, unfortunately, was malignant, but not metastatic (:confused: I need to do my research on this) - a nerve sheath tumor which will (may?) repeatedly grow back and will need to be removed each time.

Here's a photo of the poor pup earlier in the week, sporting a very stylish shave, and a little bleary-eyed from the sedatives. (He doesn't look quite so woe-begone all the time these days! And yes, he hates that plastic cone!)

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[Veronica]

Thanks for the update. Let's hope for no growth!

V.

[chickwhorips]

hopefully that growth doesn't come back.

awe.... look at that face!
peanut was terrified of that cone. she got it caught on the carpet once and just laid on the floor and shook. wouldn't even move. so i put a t-shirt on her so she couldn't lick her stitches, and took off the cone. she still had that same look but at least she would move.