Prepping for the TPLO

TPLO instruction sheet provided by the vet.

The vet provided informative background information.

So, back to the subject of my dog Luna and her TPLO (Tibial Plateau Leveling Osteotomy) surgery performed on July 26, 2012. I hoped the procedure would return function to her right rear leg, which had a ruptured cranial cruciate ligament.  Luna had become a three-legged dog, holding her injured leg in the air as she hobbled about.  Hopefully the surgery would render her a four-legged once again.

Deciding to do the surgery was a step-by-step process of my finding answers to basic questions such as, “Can I afford this? (The estimated cost for the procedure: $3700 to $4100. Follow-up x-rays: $275 to $325. Perhaps rehabilitation fees, too.) How will I pay? Will this surgery truly help my 10 year-old doggie? How much will she suffer afterward? Do I have the ‘bandwidth’ to nurture her during her recovery immediately after the surgery and for the next six to eight weeks of healing? Can I find a top-notch, experienced surgeon and first-rate surgical facility?” And, the “the clincher”: “What does Luna want to do?”

I spent a few weeks working through these questions. I dragged my feet a bit, hoping against all the odds that Luna’s leg would heal on its own. It did not.

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Menu from the vet’s excellent website.

I set up an appointment for a surgical consultation, which included the surgeon reviewing Luna’s x-rays on a light box, observing her walk, and covering all of the details related to the surgery, including preparing my house for her recovery,  “prep-ing” her for the surgery, picking her up after the surgery, and then managing her recovery.  He said that Luna was an excellent candidate for a TPLO and that it could improve her quality of life. (The links are to the vet’s website, which I studied carefully.)

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Luna tries out a rug.

He also mentioned that she needed to lose weight. He was correct, of course. But I had no idea at the time exactly how serious her weight problem was and just how it would impact her recovery.

As suggested, I bought area rugs and laid them on the kitchen and dining room floors, the rooms that she would be confined to for weeks during recovery.  The rugs would prevent her from slipping on bare floors. I bought “baby gates” at GoodWill to limit her travels about the house. I arranged to take a few days off work so that I could be with her during the days immediately after the surgery.

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Luna seemed “tuned in” and aware that something big was going to happen.

And, my final step in the process was to search the web for and to check out books from the library about communicating with animals.  I talked out loud with Luna and also tried my version of telepathy with her.  I’m not sure how successful I was… All I can say is that despite her painful leg and her limited mobility, Luna seemed energetic, alert, engaged, and connected with me. She seemed “up for it.”

So, no food after midnight the night before the surgery. Allow her to pee and poop in the morning. Deliver her to the clinic between 8 a.m. and 9 a.m. And then start envisioning a smooth procedure and a good outcome. (The last being my idea, not the vet’s suggestion.)

Thus began what would become a completely absorbing experience.

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How much would you spend on a sick pet?

Seeing how a dog's anatomy works helps demystify the proposed surgery.

One of the difficult things about making decisions about medical treatment for a pet is knowing so little about its anatomy. Visual aids help.

Most pet owners say that cost is a factor when deciding whether to seek medical care for a sick dog or cat. (Hardly a surprise.)

In a survey conducted in 2010, most pet owners (62%) say they would be likely to get vet treatment even if the bill reached $500. That means 38% said that $500 might be too much to spend on their pet.

What if the vet bill reached $1,000? Only 42% say they would be very likely to spend that much at the vet.

If the cost goes up to $2,000, 35% would pay, and if the cost reaches $5,000, 22% would foot the bill.

People earning below $50K answered about the same way as those earning $50K and up. (Interesting.)

 When faced with the prospect of spending up to $5,000 on a surgical procedure and related care for Luna, I was, well, confused, worried.   What criteria should I use to make my decision?

Rather than setting an arbitrary amount that I would be willing to spend, I found myself asking questions of veterinary medicine providers, my friends, family, and even relative strangers:

Luna's breath on my camera lens caused it to fog. This is how I felt when first facing the question about whether to get TPLO surgery for Luna: Very foggy.

I was in a fog about how to decide whether to get expensive orthopedic surgery for Luna. My choice became clear as I worked through my questions. Others may have come to a different conclusion.

“Will this surgery truly improve Luna’s quality of life or will it prolong suffering? How do other dogs do afterwards?”

 “What are the chances something will go wrong?”

“I am new to dog ownership. I can see Luna is aging at warp speed compared with humans. How does that reality enter into this decision?”

“Does Luna understand the dilemma? If so, what would she want me to do?

“How will I feel if I choose not to get the surgery done and see Luna become increasingly incapacitated and in more pain?”

“How would I feel if I ‘go for it’ and see her regain some function and quality of life?”

“What are the ‘opportunity costs’ of spending my hard-earned money on vet bills? What will I sacrifice?” (I am firmly ensconced in the ranks of the 99%, so sacrifice will be necessary.)

When I asked other people what they would do, many were amazingly opinionated. It was a kind of litmus test for attitudes toward pet ownership, the value of an animal’s life, and how one uses money. This made for fascinating conversation.

So, let me ask you.

How does a dog's knee work? What happens when the cruciate ligament ruptures? What will the surgery do?

How does a dog’s knee work? What happens when the cruciate ligament ruptures? What will the surgery do? How much function do dogs typically regain after the surgery?

How much would you spend on a sick pet?

What criteria do you consider when making a decision about veterinary care?

Have you ever paid for veterinary care that you later wish you had not pursued?

Have you ever had a feeling for what your pet would prefer? How did your pet communicate that to you?

What would you do?

Where did my last post leave us? Luna needed an x-ray of her right rear knee to help determine the source of her pain.

I set up the appointment for the x-ray, which included sedation. While Luna was “under”, the vet would check for the “drawer sign” to determine if her cranial cruciate ligament was injured. (The sedation, x-ray, and diagnosis cost about $300.)

Example of an x-ray of a dog’s rear legs: Google Image Result for http://3.bp.blogspot.com/_l4hR6L3JmB0/TPW9zrfeGDI/AAAAAAAAD48/sElcPUG5rt4/s1600/0LINGUI.jpg.

If you have followed along from the beginning, you’ll know what the vet discovered: A positive drawer sign—Luna’s ligament was either torn or fully ruptured.

More bad news: The chances were reasonably high that the ligament in her other knee was torn as well, or would be soon: This problem often comes in pairs.

The good news: The x-ray showed a minimal amount of arthritis in the injured joint.

What to do? I could–

“Here I am. In my element. What could be better than the scent of a field mouse in tall grass?

Do nothing and run the risk of Luna becoming increasingly, or, frighteningly, completely lame. (When I asked what happens when a dog has torn ligaments in both rear legs, the vet said, “I know of perfectly healthy dogs that have been put down because of lameness.”)

Try weight loss and swimming rehabilitation, which could help, but would not fix the problem.

Get a significant surgery, a TPLO (tibial plateau leveling osteotomy), requiring an overnight stay at a veterinary hospital, eight to ten weeks of recovery, real pain, and a real risk of complications.

Fortunately, some of the best veterinary surgeons to be found anywhere and a stellar surgical clinic were nearby.

But, a TPLO surgery would cost $90 for a surgical consultation fee, between $3,600 and $4,100 for the surgery, and from $300 to $600 for follow-up x-rays to check on the healing. And, there was a possibility Luna might need rehabilitation, which would be a few hundred dollars more. (OMG! That is totally scary on every front!)

Did I trust the vet who gave me this information? Completely. Unequivocally.

Did I know what to do next?  No.

What would you do?  More about this in an upcoming post.

Moving toward the TPLO…

But not too quickly. A bit more about the dog:

I immediately discovered that Luna could walk out of the door into any kind of weather without a backpack, jacket, socks, or shoes and be perfectly comfortable. That is amazing to see up close. As a new dog owner I was easily, very easily, impressed. 

Luna was clearly smart and perceptive. I could see her watching me watching her.

She could be fabulously stubborn—normal for a Chow-Chow breed. And, her gentle spirit was exactly as advertised by the shelter. That has grown over time to become “legendary”.

So, my new dog has a glowing orb on her neck. I knew she was  extra-wonderful!

Luna’s collar catches the light in one of my first photos of her. She seems regal.

In one of the first pictures I took of Luna, the fluorescent collar I placed around her neck to differentiate her from the nighttime darkness, caught light and glowed.  I was charmed—it was as if my new dog could create her own light.

Fast Forward Five Years: Luna began to refuse walks. She did not want to play on the beach. When I took her to her favorite moussing grounds on Whidbey Island, she declined the hunt. She occasionally did not get off the couch when I came home.

It was time for a “serious vet visit.” I was scared. She, as always, approached the appointment with calm equanimity until we got to the parking lot. There I had to block her end runs for freedom and lure her with cheese and turkey into the vet’s office.

"Have you noticed that just being on a beach is enough?"

Luna in her younger days, when soft sand was a joy, not a pain-inducer for a sore knee.

The blood test was normal. “She seems to be OK, but she’s way too fat. She may be arthritic. Let’s try a non-steroidal anti-inflammatory. And, put her on a weight loss diet now.”

The pounds had been creeping aboard as Luna moved less. In my ignorance, I had enabled her weight gain by providing too much delicious, healthy food. Way too much.

In just a few weeks, Luna began holding her right rear leg off the ground, walking on just three legs.  At a follow-up visit, the vet reached to examine Luna’s right rear knee joint and Luna snapped with a wolf-like snarl. She was in pain. 

We need to sedate her so that we can x-ray her knee. For that you will need to make an appointment, bring her in the morning and leave her here most of the day.”

"This is my favorite pillow. I am very comfortable when I lay here."

Luna takes it easy, resting. Her right rear knee is painful. “Things are good if no walking is required!”

The doctors were in data-gathering mode: Her blood work is good, but her knee is bad. How bad? What will an x-ray show? Is it arthritis or is it a ruptured or torn cranial cruciate ligament? The first could require anti-inflammatories. The second could require a colossal surgery, a TPLO, with many weeks of recovery and, even doggie rehab.

 Evaluating the problem correctly, making an accurate diagnosis, was a critical first step in the direction of a good outcome. The diagnostic tests were going to cost, but they were necessary.

What did Luna think about all of this? It was now May, 2012, and her leg had most likely been quite painful for weeks. I tried to remain calm, positive, hopeful  though my fears sometimes ran away with me.

More tomorrow about the path to Luna’s TPLO surgery.

From the beginning…My travels with Luna

"I smell a field mouse. What could be more intoxicating?"

Luna roams the acreage of dog-friendly Greenbank Farm on Whidbey Island in Washington state. A favorite place!

I’m going to tell you how my friendship with Luna began so that when I blog about her knee problems in the next few days, you will know something about her, perhaps have more of a feeling about the dilemma we faced.

The ad on Petfinder.com said “Princess is a Zen doggie who can ease a troubled mind—she would be a great therapy dog.” Homeward Pet, the wonderful no-kill shelter where she was being “fostered”, was in Woodinville, just a 30-minute drive away.

I had a feeling I had just found my new dog.

When I arrived at the shelter, Princess— black, furry, with beautiful almond-shaped brown eyes—was being adopted by a woman and her young-adult son. “Good for her! She has a new home!” I thought. “Onward!”

Isis, an assistant at the shelter, introduced me to other dogs at the shelter. These dogs deserve a more skillful owner”, I thought. I needed “an easy dog”—one that plays well with others and knows basic commands. I had not owned a dog before and had lots to learn. So, I left dogless, feeling a bit guilty, a little desolate.

En route home, I stopped to buy a “positive” dog-training manual that Isis recommended, Don’t Shoot the Dog by Karen Pryor. As I examined the book in the store, my phone rang, “Donna, this is Isis. Princess’ adoption fell through. She is available again.”

"Love the freedom of leash-free areas! Thank you for saving space for dogs who thrive on running, sniffing, roaming unfettered!"

Luna as I often saw her in her younger years–running ahead in a leash-free, dog-friendly area.

I returned to the shelter to take her for a walk. She pulled on the leash like a champion Iditarod sled dog. Having just perused the training book for a few minutes, I was confident I could teach her to not pull and I thought I could do it before my shoulder dislocated.  We seemed like a good match!

First things first: I re-named “Princess” “Luna” to signal a fresh start. The first thing she did was respond to her new name with grace and attentiveness. Though she was five years old—middle-aged for an 80 pound dog—she learned a new name, new tricks!

"There's a field mouse in there. I will leap straight up and pounce upon it. Fun!"

Luna poised to pounce: She smells something particularly wonderful, most likely a field mouse.

Over the past five years, we have developed a comfortable give-and-take—she stopped pulling on the leash, which made me happy, and I am certain I have changed in ways that please her (no doubt more than I know, considering how clever she is).

Even in the early days Luna occasionally held one of her rear legs up, as if it hurt. Had I known more then, I would have suspected knee problems. But, I was ignorant. She seemed to recuperate and carry on, so I thought it was “just a sore muscle”.

I know better now. Next: Moving toward the TPLO.