Re: Second Opinion re: Surgery or not

[Guest guest]

Tina,

It does seem that the recommendations of the surgeon are confusing and

questionable. I know that some on the list promote conservative management of

CCLD but if the patient is not a surgical risk for some other reason I am one

that still promotes surgery. So speaking in general terms about a patient such

as yours, you have to do something and I would strongly consider surgical

stabilization, preferably with a geometry altering procedure.

Rick Wall, DVM

[Guest guest]

If you are looking for stability and the surgery is off the table or contra-indicated by the orthopaedist, you could look into a custom orthotic for use while rehabiltating. We have had good success with the stifle orthotics made by Jeff @ K9 orthotics in the 2 cases where surgery was either not an option or could not be pursued right away (one dog was still a pup and had bilateral ruptures). I am a bit curious why cage rest and not rehab are recommended in this case, especially considering the other complicating factors.

rhea>  >> Hi All,>> I have what I thought was a very straight forward case - but when the owner went to consult with an orthopedist - he recommended rest, where I thought he would certainly recommend surgery. Could I get some thoughts from the group?

>> I have a 11.5 year old Border Collie who lives for chasing a ball. About 1 year ago she started having problems with her left hind leg. In December, she started coming to me for pain management. We started with acupuncture and she responded well. In addition to significant thickening of the left hock, there is also decreased flexion and extension. Rads show severe arthritis of the hock and stifles. She responded well and the lameness on the left hind improved. She was back to chasing the ball without minimal discomfort.

>> Then in January she pulled up acutely 3-legged lame on the right hind. I could palpate cranial drawer and I really thought she had a full tear of the CCL on the right hind. The owner was very resistant to the idea of surgery - so he opted to rest her, start her on NSAIDs and tramadol as per his general practitioner. He continued to come to me for acupuncture. At this point, the dog had swelling of the right stifle, was grade 4/5 lame on the right hind and was significantly uncomfortable on manipulation of the left hock. She was reluctant to get up and even go for short walks. In addition, she has developed a significant tightening of the iliopsoas bilaterally (which I assume is compensatory since she doesn't have a back leg to walk on!).

>> I convinced the owner to go for a consult with an orthopedist. He diagnosed her with a partial CCL tear on the right hind and confirmed the arthritis in the left hock. He recommended 6 weeks of strict rest - walks only to eliminate - and then re-evaluate. The owner was very pleased that surgery was not recommended. I expressed my concern that she would get some significant muscle atrophy so I suggested hydrotherapy to keep her moving during the 6 weeks of rest - the owner has not yet pursued hydrotherapy.

>> This week the owner came in quite dejected because the dog seems even more uncomfortable, is now collapsing on the left hind when she walks and she is not able to chase the ball.>> Does anyone think that surgery may be indicated? I feel that if we could get some stability in the right hind she would be much happier.

>> Any thoughts and suggestions would be greatly appreciated.>> Thanks,> Tina>>

[Guest guest]

I can understand the frustration. I think some people assume that surgery is not an option in older dogs. I have used Jeff's stifle braces and been very happy with them and the mid to long term outcomes.

I still feel and have objectively seen via gait analysis that surgery leads to the better short to mid term outcome than orthotics. We haven't moved far enough along to know how the long term fits but I can't imagine there will be much of a difference there.

In regards to the left stifle, is it stable? I think surgery or a brace can definitely help the left side and I still feel especially in younger dogs that surgery leads to the best long term outcome however when surgery is not an option, rehab +/- orthotics

is a great benefit in those cases. I think we need objective evidence that rehab or orthotics are going to be advantageous to the pet if we are going to recommend them in lieu of surgery which is typically considered the standard of care in CCL disease unless

surgery is not an option.

Sincerely,

, VMD, CCRP

Veterinary Orthopedic Sports Medicine Group

https://www.VOSM.com

From: VetRehab [VetRehab ] On Behalf Of Rhea McHugh [rheadawn@...]

Sent: Thursday, March 08, 2012 1:21 PM

To: VetRehab

Subject: Re: Second Opinion re: Surgery or not

If you are looking for stability and the surgery is off the table or contra-indicated by the orthopaedist, you could look into a custom orthotic for use while rehabiltating. We have had good success with the stifle orthotics made by Jeff @ K9 orthotics in

the 2 cases where surgery was either not an option or could not be pursued right away (one dog was still a pup and had bilateral ruptures). I am a bit curious why cage rest and not rehab are recommended in this case, especially considering the other complicating

factors.

rhea

>

>

> Hi All,

>

> I have what I thought was a very straight forward case - but when the owner went to consult with an orthopedist - he recommended rest, where I thought he would certainly recommend surgery. Could I get some thoughts from the group?

>

> I have a 11.5 year old Border Collie who lives for chasing a ball. About 1 year ago she started having problems with her left hind leg. In December, she started coming to me for pain management. We started with acupuncture and she responded well. In addition

to significant thickening of the left hock, there is also decreased flexion and extension. Rads show severe arthritis of the hock and stifles. She responded well and the lameness on the left hind improved. She was back to chasing the ball without minimal discomfort.

>

> Then in January she pulled up acutely 3-legged lame on the right hind. I could palpate cranial drawer and I really thought she had a full tear of the CCL on the right hind. The owner was very resistant to the idea of surgery - so he opted to rest her, start

her on NSAIDs and tramadol as per his general practitioner. He continued to come to me for acupuncture. At this point, the dog had swelling of the right stifle, was grade 4/5 lame on the right hind and was significantly uncomfortable on manipulation of the

left hock. She was reluctant to get up and even go for short walks. In addition, she has developed a significant tightening of the iliopsoas bilaterally (which I assume is compensatory since she doesn't have a back leg to walk on!).

>

> I convinced the owner to go for a consult with an orthopedist. He diagnosed her with a partial CCL tear on the right hind and confirmed the arthritis in the left hock. He recommended 6 weeks of strict rest - walks only to eliminate - and then re-evaluate.

The owner was very pleased that surgery was not recommended. I expressed my concern that she would get some significant muscle atrophy so I suggested hydrotherapy to keep her moving during the 6 weeks of rest - the owner has not yet pursued hydrotherapy.

>

> This week the owner came in quite dejected because the dog seems even more uncomfortable, is now collapsing on the left hind when she walks and she is not able to chase the ball.

>

> Does anyone think that surgery may be indicated? I feel that if we could get some stability in the right hind she would be much happier.

>

> Any thoughts and suggestions would be greatly appreciated.

>

> Thanks,

> Tina

>

>

[Guest guest]

Hi Tina

I would agree with the others that custom orthotics would be a good option for this dog. I have been really happy with the tarsal braces on dogs with achilles issues, OCD and arthritis. There are some good videos of dogs in stifle and tarsus braces online at orthopets.com. It does not replace surgery but is id an option for a dynamic support to allow rehab and give support and pain relief at the same time.

Second Opinion re: Surgery or not

Hi All,I have what I thought was a very straight forward case - but when the owner went to consult with an orthopedist - he recommended rest, where I thought he would certainly recommend surgery. Could I get some thoughts from the group?I have a 11.5 year old Border Collie who lives for chasing a ball. About 1 year ago she started having problems with her left hind leg. In December, she started coming to me for pain management. We started with acupuncture and she responded well. In addition to significant thickening of the left hock, there is also decreased flexion and extension. Rads show severe arthritis of the hock and stifles. She responded well and the lameness on the left hind improved. She was back to chasing the ball without minimal discomfort. Then in January she pulled up acutely 3-legged lame on the right hind. I could palpate cranial drawer and I really thought she had a full tear of the CCL on the right hind. The owner was very resistant to the idea of surgery - so he opted to rest her, start her on NSAIDs and tramadol as per his general practitioner. He continued to come to me for acupuncture. At this point, the dog had swelling of the right stifle, was grade 4/5 lame on the right hind and was significantly uncomfortable on manipulation of the left hock. She was reluctant to get up and even go for short walks. In addition, she has developed a significant tightening of the iliopsoas bilaterally (which I assume is compensatory since she doesn't have a back leg to walk on!).I convinced the owner to go for a consult with an orthopedist. He diagnosed her with a partial CCL tear on the right hind and confirmed the arthritis in the left hock. He recommended 6 weeks of strict rest - walks only to eliminate - and then re-evaluate. The owner was very pleased that surgery was not recommended. I expressed my concern that she would get some significant muscle atrophy so I suggested hydrotherapy to keep her moving during the 6 weeks of rest - the owner has not yet pursued hydrotherapy.This week the owner came in quite dejected because the dog seems even more uncomfortable, is now collapsing on the left hind when she walks and she is not able to chase the ball. Does anyone think that surgery may be indicated? I feel that if we could get some stability in the right hind she would be much happier.Any thoughts and suggestions would be greatly appreciated.Thanks,Tina

[Guest guest]

Tina,

Any diagnostics performed? What is the Lyme status of this patient? RA? Tick

profile?

This email is from my Iphone. Please excuse the necessary brevity.

JD

[Guest guest]

I would sure be interested to know why the orthopod thought surgery was not the

way to go. I would agree that surgery is the current gold standard for these

and in my experience the outcomes have definitely been better both short, mid

and long term. If for some reason surgery cannot be done then rehab with or

without an orthotic is the best you have. I am eagerly awaiting some kind of

data on orthotics providing true translational stability in a cruciate deficient

stifle. Good luck with that one.

Cheers

Bruce DVM, Dip ACVS

Alta Vista Animal Hospital

>

> Hi All,

>

> I have what I thought was a very straight forward case - but when the owner

went to consult with an orthopedist - he recommended rest, where I thought he

would certainly recommend surgery. Could I get some thoughts from the group?

>

> I have a 11.5 year old Border Collie who lives for chasing a ball. About 1

year ago she started having problems with her left hind leg. In December, she

started coming to me for pain management. We started with acupuncture and she

responded well. In addition to significant thickening of the left hock, there

is also decreased flexion and extension. Rads show severe arthritis of the hock

and stifles. She responded well and the lameness on the left hind improved.

She was back to chasing the ball without minimal discomfort.

>

> Then in January she pulled up acutely 3-legged lame on the right hind. I

could palpate cranial drawer and I really thought she had a full tear of the CCL

on the right hind. The owner was very resistant to the idea of surgery - so he

opted to rest her, start her on NSAIDs and tramadol as per his general

practitioner. He continued to come to me for acupuncture. At this point, the

dog had swelling of the right stifle, was grade 4/5 lame on the right hind and

was significantly uncomfortable on manipulation of the left hock. She was

reluctant to get up and even go for short walks. In addition, she has developed

a significant tightening of the iliopsoas bilaterally (which I assume is

compensatory since she doesn't have a back leg to walk on!).

>

> I convinced the owner to go for a consult with an orthopedist. He diagnosed

her with a partial CCL tear on the right hind and confirmed the arthritis in the

left hock. He recommended 6 weeks of strict rest - walks only to eliminate -

and then re-evaluate. The owner was very pleased that surgery was not

recommended. I expressed my concern that she would get some significant muscle

atrophy so I suggested hydrotherapy to keep her moving during the 6 weeks of

rest - the owner has not yet pursued hydrotherapy.

>

> This week the owner came in quite dejected because the dog seems even more

uncomfortable, is now collapsing on the left hind when she walks and she is not

able to chase the ball.

>

> Does anyone think that surgery may be indicated? I feel that if we could get

some stability in the right hind she would be much happier.

>

> Any thoughts and suggestions would be greatly appreciated.

>

> Thanks,

> Tina

>

[Guest guest]

After these tests, and appropriate treatment, if needed, I would consider

prolotherapy. All joints involved can benefit. Even if RA, can give great

stability and pain control.

Judith Shoemaker,DVM

Sent via BlackBerry by AT & T

Re: Second Opinion re: Surgery or not

 

Tina,

Any diagnostics performed? What is the Lyme status of this patient? RA? Tick

profile?

This email is from my Iphone. Please excuse the necessary brevity.

JD

[Guest guest]

Hi Everyone,

Thank you for all of the input - I will be sure to pass these ideas along. If

anyone else wants to chime in - I'll pass that on as well.

I'm 75% sure this dog has recently been tested for tick borne diseases at the

local vet - I'll be sure to confirm.

I've already mentioned prolotherapy to the owner - so we'll see what he decides.

He comes in next week - I'll keep everyone posted to what he decides to do.

Thank you again,

Tina

[Guest guest]

I need to find a rhab center near Midlothian,VA, the patient is a wonderful Boxer with DM and needs therapy as an outpatient due to anxiety. Owner is moving at the end of. April, Dog is still ambulatory and recently had a TPLO, does great in UTM, any reccomendations are very appreciated! Thankyou!Sent via BlackBerry by AT&TSender: VetRehab Date: Fri, 09 Mar 2012 14:24:48 -0000To: <VetRehab >ReplyTo: VetRehab Subject: Re: Second Opinion re: Surgery or not I would sure be interested to know why the orthopod thought surgery was not the way to go. I would agree that surgery is the current gold standard for these and in my experience the outcomes have definitely been better both short, mid and long term. If for some reason surgery cannot be done then rehab with or without an orthotic is the best you have. I am eagerly awaiting some kind of data on orthotics providing true translational stability in a cruciate deficient stifle. Good luck with that one.Cheers Bruce DVM, Dip ACVSAlta Vista Animal Hospital>> Hi All,> > I have what I thought was a very straight forward case - but when the owner went to consult with an orthopedist - he recommended rest, where I thought he would certainly recommend surgery. Could I get some thoughts from the group?> > I have a 11.5 year old Border Collie who lives for chasing a ball. About 1 year ago she started having problems with her left hind leg. In December, she started coming to me for pain management. We started with acupuncture and she responded well. In addition to significant thickening of the left hock, there is also decreased flexion and extension. Rads show severe arthritis of the hock and stifles. She responded well and the lameness on the left hind improved. She was back to chasing the ball without minimal discomfort. > > Then in January she pulled up acutely 3-legged lame on the right hind. I could palpate cranial drawer and I really thought she had a full tear of the CCL on the right hind. The owner was very resistant to the idea of surgery - so he opted to rest her, start her on NSAIDs and tramadol as per his general practitioner. He continued to come to me for acupuncture. At this point, the dog had swelling of the right stifle, was grade 4/5 lame on the right hind and was significantly uncomfortable on manipulation of the left hock. She was reluctant to get up and even go for short walks. In addition, she has developed a significant tightening of the iliopsoas bilaterally (which I assume is compensatory since she doesn't have a back leg to walk on!).> > I convinced the owner to go for a consult with an orthopedist. He diagnosed her with a partial CCL tear on the right hind and confirmed the arthritis in the left hock. He recommended 6 weeks of strict rest - walks only to eliminate - and then re-evaluate. The owner was very pleased that surgery was not recommended. I expressed my concern that she would get some significant muscle atrophy so I suggested hydrotherapy to keep her moving during the 6 weeks of rest - the owner has not yet pursued hydrotherapy.> > This week the owner came in quite dejected because the dog seems even more uncomfortable, is now collapsing on the left hind when she walks and she is not able to chase the ball. > > Does anyone think that surgery may be indicated? I feel that if we could get some stability in the right hind she would be much happier.> > Any thoughts and suggestions would be greatly appreciated.> > Thanks,> Tina>

[Guest guest]

Veterinary Referral and Critical Care in Goochland and Cary Street vet in

Richmond are fairly close to Midlothian

Sent from my Verizon Wireless Phone

--- Original Message ---

From: dovetailrehab@...

Sent: March 12, 2012 3/12/12

To: VetRehab

Subject: Re: Re: Second Opinion re: Surgery or not

 

I need to find a rhab center near Midlothian,VA, the patient is a wonderful

Boxer with DM and needs therapy as an outpatient due to anxiety. Owner is moving

at the end of. April, Dog is still ambulatory and recently had a TPLO, does

great in UTM, any reccomendations are very appreciated! Thankyou!

Sent via BlackBerry by AT & T

Sender: VetRehab

Date: Fri, 09 Mar 2012 14:24:48 -0000

To: <VetRehab >

ReplyTo: VetRehab

Subject: Re: Second Opinion re: Surgery or not

 

I would sure be interested to know why the orthopod thought surgery was not the

way to go. I would agree that surgery is the current gold standard for these and

in my experience the outcomes have definitely been better both short, mid and

long term. If for some reason surgery cannot be done then rehab with or without

an orthotic is the best you have. I am eagerly awaiting some kind of data on

orthotics providing true translational stability in a cruciate deficient stifle.

Good luck with that one.

Cheers

Bruce DVM, Dip ACVS

Alta Vista Animal Hospital

>

> Hi All,

>

> I have what I thought was a very straight forward case - but when the owner

went to consult with an orthopedist - he recommended rest, where I thought he

would certainly recommend surgery. Could I get some thoughts from the group?

>

> I have a 11.5 year old Border Collie who lives for chasing a ball. About 1

year ago she started having problems with her left hind leg. In December, she

started coming to me for pain management. We started with acupuncture and she

responded well. In addition to significant thickening of the left hock, there is

also decreased flexion and extension. Rads show severe arthritis of the hock and

stifles. She responded well and the lameness on the left hind improved. She was

back to chasing the ball without minimal discomfort.

>

> Then in January she pulled up acutely 3-legged lame on the right hind. I could

palpate cranial drawer and I really thought she had a full tear of the CCL on

the right hind. The owner was very resistant to the idea of surgery - so he

opted to rest her, start her on NSAIDs and tramadol as per his general

practitioner. He continued to come to me for acupuncture. At this point, the dog

had swelling of the right stifle, was grade 4/5 lame on the right hind and was

significantly uncomfortable on manipulation of the left hock. She was reluctant

to get up and even go for short walks. In addition, she has developed a

significant tightening of the iliopsoas bilaterally (which I assume is

compensatory since she doesn't have a back leg to walk on!).

>

> I convinced the owner to go for a consult with an orthopedist. He diagnosed

her with a partial CCL tear on the right hind and confirmed the arthritis in the

left hock. He recommended 6 weeks of strict rest - walks only to eliminate - and

then re-evaluate. The owner was very pleased that surgery was not recommended. I

expressed my concern that she would get some significant muscle atrophy so I

suggested hydrotherapy to keep her moving during the 6 weeks of rest - the owner

has not yet pursued hydrotherapy.

>

> This week the owner came in quite dejected because the dog seems even more

uncomfortable, is now collapsing on the left hind when she walks and she is not

able to chase the ball.

>

> Does anyone think that surgery may be indicated? I feel that if we could get

some stability in the right hind she would be much happier.

>

> Any thoughts and suggestions would be greatly appreciated.

>

> Thanks,

> Tina

>

[Guest guest]

Thankyou, Cary st. Will not do outpatient. We will try the other one!Sent via BlackBerry by AT&TSender: VetRehab Date: Fri, 16 Mar 2012 11:56:04 -0700 (PDT)To: <VetRehab >ReplyTo: VetRehab Subject: Re: Re: Second Opinion re: Surgery or not Veterinary Referral and Critical Care in Goochland and Cary Street vet in Richmond are fairly close to MidlothianSent from my Verizon Wireless Phone--- Original Message ---From: dovetailrehab@...Sent: March 12, 2012 3/12/12To: VetRehab Subject: Re: Re: Second Opinion re: Surgery or not  I need to find a rhab center near Midlothian,VA, the patient is a wonderful Boxer with DM and needs therapy as an outpatient due to anxiety. Owner is moving at the end of. April, Dog is still ambulatory and recently had a TPLO, does great in UTM, any reccomendations are very appreciated! Thankyou!Sent via BlackBerry by AT & TSender: VetRehab Date: Fri, 09 Mar 2012 14:24:48 -0000To: <VetRehab >ReplyTo: VetRehab Subject: Re: Second Opinion re: Surgery or not  I would sure be interested to know why the orthopod thought surgery was not the way to go. I would agree that surgery is the current gold standard for these and in my experience the outcomes have definitely been better both short, mid and long term. If for some reason surgery cannot be done then rehab with or without an orthotic is the best you have. I am eagerly awaiting some kind of data on orthotics providing true translational stability in a cruciate deficient stifle. Good luck with that one.Cheers Bruce DVM, Dip ACVSAlta Vista Animal Hospital>> Hi All,> > I have what I thought was a very straight forward case - but when the owner went to consult with an orthopedist - he recommended rest, where I thought he would certainly recommend surgery. Could I get some thoughts from the group?> > I have a 11.5 year old Border Collie who lives for chasing a ball. About 1 year ago she started having problems with her left hind leg. In December, she started coming to me for pain management. We started with acupuncture and she responded well. In addition to significant thickening of the left hock, there is also decreased flexion and extension. Rads show severe arthritis of the hock and stifles. She responded well and the lameness on the left hind improved. She was back to chasing the ball without minimal discomfort. > > Then in January she pulled up acutely 3-legged lame on the right hind. I could palpate cranial drawer and I really thought she had a full tear of the CCL on the right hind. The owner was very resistant to the idea of surgery - so he opted to rest her, start her on NSAIDs and tramadol as per his general practitioner. He continued to come to me for acupuncture. At this point, the dog had swelling of the right stifle, was grade 4/5 lame on the right hind and was significantly uncomfortable on manipulation of the left hock. She was reluctant to get up and even go for short walks. In addition, she has developed a significant tightening of the iliopsoas bilaterally (which I assume is compensatory since she doesn't have a back leg to walk on!).> > I convinced the owner to go for a consult with an orthopedist. He diagnosed her with a partial CCL tear on the right hind and confirmed the arthritis in the left hock. He recommended 6 weeks of strict rest - walks only to eliminate - and then re-evaluate. The owner was very pleased that surgery was not recommended. I expressed my concern that she would get some significant muscle atrophy so I suggested hydrotherapy to keep her moving during the 6 weeks of rest - the owner has not yet pursued hydrotherapy.> > This week the owner came in quite dejected because the dog seems even more uncomfortable, is now collapsing on the left hind when she walks and she is not able to chase the ball. > > Does anyone think that surgery may be indicated? I feel that if we could get some stability in the right hind she would be much happier.> > Any thoughts and suggestions would be greatly appreciated.> > Thanks,> Tina>