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"-partially torn cranial cruciate ligament (ACL); will need Tibial Plateau Leveling Osteotomy (TPLO) surgery.
-Hip dysplasia, one side; will need hip replacement."20190208_110151.thumb.jpg.35e64c1ccc96fb85fcf6536bf2ebc473.jpg

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Hello, @billdozer- just happened upon your post in my Unread Messages. Your title seems to be asking for advice, but don’t see a question. Your first sentence, though, would actually be referring to a partially torn ANTERIOR cruciate ligament? For humans, not sure how that repair or reconstruction would need a tibial plateau leveling osteotomy- maybe canines are different?

A hip replacement at such a young age- gosh. Am sure all this must feel devastating. 

Will follow -

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Hi @Ranchhand- thank you for your response. I have been through an interesting few weeks so sorry for taking awhile to get back with you. 

I'll start by saying this: Bear actually does not have torn ligaments. He has "slight hip dysplasia," in fact so slight that the vet doesn't even want to touch them yet. 

The Story: I took him to the local vet I have been using for the past two years after I noticed him kind of "carrying" his leg when he walked. I just started my second semester of law school so I wanted to have him x-rayed to have peace of mind about it. The above x-rays and diagnoses are theirs.They also told me he had "severe arthritis" and prescribed him two months of medication until I found a surgeon.

So, relying on their opinion, I found a specialist, and scheduled him for surgery. When we arrived at the specialist, the vet acted really surprised. He had me walk Bear up and down the halls and do a series of stretches and squeezes around his body. Based on this assessment he was "amazed that I even noticed a problem with him." (I have to brag here— he said most dog owners would have no clue and that the only reason he could tell something was abnormal was because he is a "fucking vet" lol). He said that he didn't like the x-rays that were previously taken, and that he wanted to re-take them.

After taking x-rays, he had this to say (paraphrased): "I am really unsure what the other vet was basing their diagnosis on. I found no signs of any arthritis. He does not have torn ligaments. The only thing he does have is some slight hip dysplasia, which, after a long day of outdoor activity, may be causing him some discomfort. I don't recommend the hip replacement yet, because I feel like if I cut him open at this stage, I will do more harm than good." 

Here is an X-ray he took… look at the difference: 

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Can you believe this? I was so shocked about the difference in x ray quality that I even cross-checked the image on the deep and dark web to see if I was getting scammed lol.

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Sometimes, just going to a specialist can make all the difference in the world. The quality of the x-ray (and particularly the skill of those placing the dog for the x-ray) is just one aspect that could be different. 

For my Celt, he was diagnosed with a torn CCL when he was six. Rather than having at TTA done on him by my local vet who does quite a bit of ortho work but is not certified (that I am aware of), I took him to a specialist who re-examined him, looked at his films, observed him, and felt he only had either a strain or a minor tear. With meds and crate rest, it was three years before he actually tore the CCL completely and required surgery. And, had I been more proactive in his meds--and-rest phase, I wonder...

In addition, the specialist that did the surgery did a TPLO, which was more expensive than a TTA but which he felt, with his 25 years of ortho surgical practice, was the superior treatment for an active dog. He pointed out that he used to do TTAs but felt that the results, over time, were not as good as those with the TPLOs. 

Celt, who first had issues at age six with the strain or partial, the total tear at age nine, a total tear on the other CCL at age eleven, continued to work our cow herd until age thirteen, as testament to good and timely treatment when it was needed. He is still, at sixteen years of age last November, active and able to walk several miles most days. 

Additionally, many Border Collies with certain levels of hip dysplasia can maintain a very good quality of life without surgery by being kept at a lean body weight and in good muscular condition. The support that fit muscling can give to the joints is important and can be very stabilizing. Many people have found, to their surprise, upon x-rays, that their apparently totally sound dog had a certain laxity in the hip joint that was compensated for by lean weight and muscular fitness. Good advice for us all, I guess! 

I am very glad that you got good news! And there is nothing better than a good and honest vet who says your dog *doesn't* need surgery! 

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2 hours ago, Sue R said:

Additionally, many Border Collies with certain levels of hip dysplasia can maintain a very good quality of life without surgery by being kept at a lean body weight and in good muscular condition. The support that fit muscling can give to the joints is important and can be very stabilizing...

Can't emphasize this enough.

Not only this, but a dog whose musculature is not fit can actually show different results on X-ray. Many years ago I had one of my dogs OFA tested and was disappointed to find he was mildly dysplastic. After discussing this with my vet he reminded me that the dog had had some sort of infection that had kept him from working for several weeks and wasn't as fit as he normally was. He pointed out that the muscles may have weakened, affecting the joint laxity and recommended that I submit a second set of X-rays to OFA in a couple months now that the dog was back to work. I followed his advice and the on the next screening the dog's hips were rated fair. It's not great, but it's a difference of 2 grades from mildly dysplastic (there's a "borderline" grade in between mild and fair).

 

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On 2/24/2019 at 9:03 AM, Sue R said:

For my Celt, he was diagnosed with a torn CCL when he was six. Rather than having at TTA done on him by my local vet who does quite a bit of ortho work but is not certified (that I am aware of), I took him to a specialist who re-examined him, looked at his films, observed him, and felt he only had either a strain or a minor tear. With meds and crate rest, it was three years before he actually tore the CCL completely and required surgery. And, had I been more proactive in his meds--and-rest phase, I wonder...

In addition, the specialist that did the surgery did a TPLO, which was more expensive than a TTA but which he felt, with his 25 years of ortho surgical practice, was the superior treatment for an active dog. He pointed out that he used to do TTAs but felt that the results, over time, were not as good as those with the TPLOs.

We are facing this now with Lucky. He's scheduled for surgery in a week - we've opted for the TTA - but in our case the TTA is more expensive with the titanium implant.  We've had him examined by a ortho vet who does both procedures regularly.  But we are seriously wondering if we are jumping the gun with surgery.  He's still very mobile and able to run around and jump through the woods.  He does limp an favor his leg getting up from lying down - especially if he hasn't had a pain pill for the day.   We tried the meds and rest for 4 weeks but, when we went back to regular exercise (running off leash in the woods - we've completely stopped playing ball and frisbee with him) he would favor his leg again.  

I know he is experiencing some pain, but I worry that we'll be putting him through a horrible ordeal of surgery when we might not need to  - or not need to yet.  He's only 3.5 years old.

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47 minutes ago, LuckytheDog said:

We are facing this now with Lucky. He's scheduled for surgery in a week - we've opted for the TTA - but in our case the TTA is more expensive with the titanium implant.  We've had him examined by a ortho vet who does both procedures regularly.  But we are seriously wondering if we are jumping the gun with surgery.  He's still very mobile and able to run around and jump through the woods.  He does limp an favor his leg getting up from lying down - especially if he hasn't had a pain pill for the day.   We tried the meds and rest for 4 weeks but, when we went back to regular exercise (running off leash in the woods - we've completely stopped playing ball and frisbee with him) he would favor his leg again.  

I know he is experiencing some pain, but I worry that we'll be putting him through a horrible ordeal of surgery when we might not need to  - or not need to yet.  He's only 3.5 years old.

 

Remember that your goal with the surgery is to PREVENT arthritic changes and worsening from use of a messed up knee down the road that will seriously hinder him LATER, not to deal with a situation that's making him immobile NOW.   


So basically: I think your right in doing the surgery.  This isn't jumping the gun.  The sooner his knee is fixed, the less damage he will have down the road. Waiting for him not to be able to walk without limping or to be carrying that leg all the time is going to let everything get worse, make recovery harder, and give you a less positive outcome.

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@LuckytheDog will you keep us updated on how Lucky is doing? :) 

To update everyone on Bear:

He is doing very well. We have worked to find alternative methods of stimulation that don't tax his body as much:

  • reduced frisbee to once a month. when throwing it, keeping the frisbee low to avoid jumping.
  • hiking at a moderate pace. I let him explore, and we take breaks in the shade.
  • engage in more "brain games" like hide and go seek with treats, toys, etc.
  • swimming (he loves this during the summer...but be careful, he has cut his foot twice, find a good spot that isn't heavily used)
  • social situation training. for instance, I will take him downtown and test his ability to act in social situations, treating him and praising him when he does a good job. this one I cannot stress enough. we had done this previously, but since the diagnosis we've increased the amount of time spent doing this. it has been awesome for us. he LOVES people. he LOVES other dogs. So when he does a good job of keeping his cool and being respectful of others, his reward is more exposure time. it keeps his confidence high and his brain engaged. 

A lot this stuff I'm assuming most of you on here already know. But, I just wanted to throw this out there because chances are SOMEONE will benefit from reading. 

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@billdozer I just saw your post!

We did the TTA surgery on Lucky in March and it went really well.  The recovery at the beginning was HARD.  We had to keep him sequestered in a pen we built in the kitchen.  He couldn't go upstairs or in the rest of the house (we have lots of slippery wood floors) for 16 weeks, which at the beginning was really hard for him since he was used to being in the house wherever we were all of the time, especially at night.  My husband and I took turns sleeping in the kitchen with him for the first few nights. 

But we followed the recovery instructions pretty exactly - no  walks for the first 8 weeks - only out on a short leash for pee/poo.  After 8 weeks he was allowed leash walks, starting at 5 minutes per day and gradually increasing by 5 minutes every 3 days.   At 16 weeks, he's allowed off leash running, but we haven't been playing ball or frisbee and don't plan on it since we think that's how he injured himself.

He's very happy to be allowed to be off leash in the woods again!

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