January 26, 2001
I am afraid.
On January 23 I thought I noticed my 4 year old Labrador Darby take a misstep. I watched her closely, but I didn't see any evidence of trouble.
Darby is a highly explosive canine athlete. She is my Agility dog. She just earned her first agility title and did it with 2 First places and 1 Second place in the 20 inch Novice standard class. She is fantastic at agility and we were looking forward to moving upwards in the classes.
It was during our practice of doing the weave poles that I thought I first saw a misstep. Later that evening we were doing the weaves poles again and I thought I saw another misstep. When I called a halt to the lesson, she flew up the stairs and danced and wiggled at the top waiting for me to make my way up. With that demonstration, I totally ignored what I thought I saw.
It was about 3 in the morning that I noticed she was tentative in putting weight on her leg when going out with my 2 year old Lab Shanny. By the way she was using the leg and holding it, my mind silently screamed cruciate ligament. Oh God, please no I prayed.
I had just gotten my Labrador Quarterly (winter 2001) that day and one of the first articles I had read was on cruciate ligament damage. How ironic.
Later when my vet opened I called and told them I thought Darby had blown out her cruciate. They scheduled us for an appointment for later in the afternoon. Being the hard bodied athlete she is, Darby's thigh is very heavily muscled. My vet was unable to move the joint as required to determine the extent of the injury. We scheduled Darby to come in the next day where she would be anesthetized so the vet could manipulate the joint.
Needless to say, I was dreading what I was going to be told. I kept praying that it would be a sprain. However, it was not to be. The vet determined it was a partial tear of the ligament which meant surgery was required to fix it. Some good news was that the meniscus did not seem to be torn and the x-rays showed no arthritic changes in the joint. My vet said that because I was so in tune with my dogs, I noticed the injury before it got too bad and caused further damage to the joint. This didn't mean that further damage couldn't happen with each passing day. Darby was to have complete crate rest and only going outside for potty breaks.
I started reading all I could on this injury. My mind is in information overload right now. I put "canine cruciate ligament" into a search engine on the Internet and one of the first sites I found was http://lauriebryce.com/tplo/ . This site dealt with an owner and her Bernese Mountain Dog who suffered a couple of ACL (Anterior Cruciate Ligament) tears.
What I read frightened me greatly. How could I ever keep this very active dog quiet for at least 8 weeks after surgery? Darby already is whining in the crate with boredom after 2 days. Plus I have 5 other dogs, including the very active adolescent named Shanny. Shanny and Darby are playing buddies. Shanny tends to be very naughty if she doesn't get her daily attention and play time. I have my doubts I can pull this off.
Next I learned there are various types of repair surgeries. The typical where "Extracapsular stabilization techniques involve stabilizing the stifle by some means external to the joint capsule. The most common technique involves placing large, nonabsorbable suture around the lateral fabella and through a hole in the tibial crest. There are many variations of this technique but the principle is basically the same; the external suture mimics the course of the CCL and acts to prevent cranial drawer. This is similar to what surgeons did to my own ligament in my right knee when I was 26 years old. It didn't work well with me and I still have knee pain and instability.
The fibular head transposition technique uses the lateral collateral ligament to mimic the function of the CCL. As the lateral collateral ligament inserts on the fibular head, advancing the fibular head cranially causes it to course in the same direction as the CCL. It is maintained in its new position with pins and wire. ¹" This is similar to the technique I had done on my own left knee when I was 14 years old. Initially I had a lot of pain and instability, but as time went on this knee rarely gives me problems beyond the normal arthritic pain.
"Intracapsular stabilization techniques involve stabilizing the stifle by some means within the joint capsule. Autogenous tissue is most commonly used but allografts and synthetic material have been used as well. Usually the lateral portion of the patellar ligament and a strip of fascia lata are harvested, passed through the joint along the same course as the cranial cruciate ligament, and anchored to the extracapsular tissues. The graft may be placed through bone tunnels in an attempt to better duplicate the anatomy of the CCL. Many variations of the intracapsular procedures exist as well.¹"
However, from what I have read it seems these types of surgeries have a lot of failures.
There is a newer, more radical technique called Tibial Plateau Leveling Osteotomy or TPLO for short. This "involves changing the angle of the tibial plateau. The tibial plateau normally has a caudally directed slope which exacerbates cranial drawer during weight-bearing. By making the plateau angle level, the stifle does not go into drawer during weight-bearing and is therefore functionally stable. This is achieved by making a radial cut in the plateau and securing the plateau fragment with a bone plate. ²" In layman's terms the tibia is actually fractured and a metal plate is installed. Then everything is screwed down. There's a risk of infection, the fracture could fail to heal, the screws could fall out of the plate. http://www.vescone.com/Departments/Surgery/Surgical%20Procedures/TPLOFAQ.HTML, http://www.sancarlosvet.com/Other/Prof/TPLO/ and http://petsurgery.com/tibialplateaulevelingosteotomy.htm describes the surgery.
I am totally confused as to what to do. I know there is at least a 30% chance of Darby injuring the other leg at a later date. The surgeries are not cheap. The standard types run about $1500 and the TPLO is about $2500. This means that whatever type I choose, I better be prepared to do the other leg too. Where on earth am I supposed to get this type of money? The money tree in the backyard has dried up. I am afraid.
The Lab community has been wonderful as always with many people emailing me and telling me of their experiences. Most told me to do the TPLO if I even thought of wanting to return Darby to agility.
I also joined an email list devoted to dogs with orthopedic problems hoping to find solace with others going through this. The name of this list is Orthodogs http://groups.yahoo.com/group/orthodogs/ and its open to anyone going through orthopedic problems with their dog whether its ACL or hip or elbow dysplasia.
Today I am meeting with the surgeon Dr. Kerstetter with the Michigan Veterinary Specialists http://www.vetsurgerycentral.com/mvs.htm who do the TPLO. I will also meet with Dr. Lucy Henney of the Oakland Veterinary Referral Services http://www.ovrs.com/. She does a more traditional technique of surgical repair. Dr. Henney took care of Kelly when she was so ill in 1990. I felt very comfortable with her at the time.
I am so afraid I cannot do this. I cannot let my brain relax or I will dissolve into tears. God give me the strength to do this and not screw it up. Give me the wisdom I need to make the right decision for Darby regarding which type of surgery.
I am about to leave for the consult with Dr. Kerstetter. Somewhere deep inside of me I am still hoping that my vet misdiagnosed Darby and its just a strain. Please God, please let this be the case.
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