Thursday, March 10, 2016

Theory and Actual Decisions for an Actual Dog Aren't the Same Thing: Cookie's Knee Injury

As it turned out, Cookie has a partially torn cruciate in her left knee. We've been through this already with Jasmine. Bad ligaments in both knees. Decisions to be made.


Back then I had no idea what a cruciate ligament was, why it would get injured and what were our options.

I had to learn everything. The option that was put before us was a TPLO surgery. I looked it up. I didn't like the TPLO. I really didn't like the TPLO. I researched all alternatives.

There was conservative management with or without a brace. There was prolotherapy. There were couple other surgery choices. And there was stem cell therapy.

We felt the stem cell treatment was the best thing to try.

We found a vet who could do that, discussed it and decided that was what were going to do. Life had different plans, though, and by the time we would have been able to do the treatment, the ligament got fully torn. We ended up doing the traditional suture technique combined with the stem cells for both Jasmine's knees. The post-op was long but everything worked out great and Jasmine's knees were as good as new once again. Or as close to it as one could hope.

Being in love with Rottweilers, we knew we might face the same problem again sooner or later.

The question was, would we approach it the same way again?

JD is a nut and we could not see how we would be able to make it trough the traditional repair post-op with him. We made up our minds that if he busted his knee(s), TPLO would indeed be the best treatment option for him. There is a different technique I personally like better, TTO, but nobody around here does that. Third option is TTA but I have mixed feelings about that one, even though they seem to have made some improvements to it.

One important criteria when choosing the type of surgery has to do with a surgeon. 

The surgeon's skill, their track record, and how comfortable they are with any given technique is at least as important as the surgical technique itself. Which, around here, really brings the options back to a single one, the TPLO.

When we adopted Cookie, our thinking was about the same - TPLO would be the best choice for her.

She too is a very active girl full of energy and enthusiasm. Going through a lengthy, vulnerable to mishaps rehab did not sounds like a good idea. So we pretty much had our minds made up what we'd do should a knee injury happen.


And then it happened.

And I still really don't like the TPLO. And the tear is only partial (at least at the moment). I found myself going through the same dilemma as the first time around. Do I really want to put Cookie through such an invasive surgery? Complications are rare but they can be pretty bad. Is there something else we could try?

Of course, should the ligament tear completely, surgery IS the best option.

But this is only a partial tear. Cookie's muscle mass is good and the knee isn't giving her too much of a hard time ... Should we just jump to chopping up bones?

Yet again, we decided to give regenerative therapy a chance.

Restoration of the ligament, of course, would be the ideal fix. Replacement of the ligament would be the second best ideal fix. Unfortunately, replacing a ligament that needs to withstand tremendous forces isn't so easy. There are places who do these kinds of surgeries, with reasonable success as it seems, but not around here.

Ligaments don't like to heal because of the lack of blood supply. Without blood bringing it what is needed for healing, healing cannot take place. Could there be a way of making up for this disadvantage? Maybe ... ?

We have decided to try platelet-rich plasma (PRP) treatment for Cookie.

There is some chance that it might work and actually get the ligament to heal. Don't we owe it to Cookie to give this a try before resorting to an invasive surgery? We certainly think so.

She's getting her treatment next Tuesday and we hope and pray it works for her. If it doesn't, surgery can always be done. Will it be the TPLO? Honestly, I still don't know the answer to that. And there we thought we had it all figured out.

Related articles:
From The End Of A Lead Line To Casa Jasmine: Meet Cookie, Our New Adoptee
And So It Begins Again(?) Our First Health-Related Heart Attack With Cookie 
I Didn't Know I Could Fly: Why Cookie Wears A Harness Instead Of A Collar
C.E.T. Oral Hygiene Chews For Dogs CAN Be A Choking Hazzard 
Our First Health-Related Heart Attack With Cookie: The Knee Or The Foot? 
Creative Solutions And An Incidental Product Review
Too Young For Pot: Cookie's Snack With A Side Of Hydrogen Peroxide  
Taming Of The Wild Beast: Cookie's Transition To Civilization  
Staying On Top Of The Ears: Cookie Is Not Impressed  
Putting The Easy Back Into Walking
Cookie's Ears Are Still Not Happy 
The Threat Of The Bulge Is Always Lurking 
Today Is Cookie's Three-Months Adoptoversary  
Cookie Meets The Electric Horse Fence And Her First Chiropractic Adjustment  
Why Examine Your Dog's Vomit? 
Why Is That Leg Still Not Happy? Cookie's Leg Keeps Getting Sore 
Cookie Too Is Insured With Trupanion
Does Being Insured Mean Being Covered? Our First Claim With Trupanion
Is Cookie's Leg Finally Getting Better?
Is Cookie Going To Be Another Medical Challenge Or Are We Looking To Closely? 
The Project That Is Cookie: Pancreatitis Up Close And Personal  
Pancreatitis: Cookie’s Blood Work   
Another Belly Upset: Pancreatitis Again Or Not?  
Happy Birthday, Cookie 
Incontinence? Cookie's Mysterious Leaks 
Who's Training Whom? Stick And Treat 
Don't Just Stand There, Do Something? Cookie's Mysterious Bumps 
Cookie's Mysterious Bumps Update
One Vomit, No Vomit 
Happy One-Year Adoptoversary, Cookie!
Cookie's Leaks Are Back: Garden Variety Incontinence Or Not?
Cookie's Leaks Update 
Don't Panic, Don't Panic: Know What Your Job Is 
The Continuing Saga Of Cookie's Leeks: Trying Chiropractic Approach 
Cookie's Minor Eye Irritation
Regular Wellness Exam: Cookie's ALT Was Elevated 
Cookie's Plantar Paw Pad Injury 
How Far To Take It When The Dog Isn't Sick?
Cookie Has Tapeworm Infection 
Cookie's Elevated ALT: The Ultrasound and Cytology  
Cookie's ALT Update
The Importance of Observation: Cookie's Chiropractic Adjustment
Sometimes You Don't Even Know What You're Looking at: Cookie's Scary "We Have No Idea What that Was" 
Living with an Incontinent Dog 
Summer Dangers: Cookie Gets Stung by a Bald-faced Hornet 
To Breathe or Not To Breathe: Cookie's Hind Legs Transiently Fail to Work (Again)
Figuring out What Might Be Going on with Cookie's Legs: The Process 
Figuring out What Might Be Going on with Cookie's Legs: The Diagnosis 
Cookie's Iliopsoas Injury Treatment: Trazodone  
Cookie's Iliopsoas Injury Treatment: Other Medications 
Cookie's Iliopsoas Injury Treatment: Laser, Hydrotherapy and Chiropractic 
Cookie's Recovery from Iliopsoas Injury: ToeGrips 
It Never Rains ... Cookie's New Injury 
Mixed Emotions: When What You Should Do Might Not Be What You Should Do for Your Dog 
Cookie's New Injury Update 
Cookie's Iliopsoas Injury: The Symptoms 
Cookie's Iliopsoas Injury: Battling the Zoomies 
Cookie's Muscle Injuries: What Else Is Going On?

Related articles:
Preventing CCL (ACL) Tears (Part 1 of series on Cruciate Ligament Tears) 
“All or None, or Partial?” (Part 2 of series on Cruciate Ligament Tears)

How The Oddysey Started: Jasmine's ACL Injury 
Talk To Me About ACL Injuries
ACL Injuries in Dogs: Non-Surgical Alternatives?
ACL Injuries in Dogs and Stem Cell Regenerative Therapy
Newest Surgery For Ruptured ACL In Dogs
Preventing ACL Injuries In Dogs
ACL Injuries In Dogs: Xena's Story 
ACL Injury Conservative Management: Sandy's Story
Surviving The Post-Op: After Your Dog's ACL Surgery
Talk to Me About Arthritis
Don't Forget the Physical Therapy 
My Love Is Sleeping At My Feet: ACL Surgery Complications 
Coco's TPLO Post-Op Diary 
Small Breeds Can Hurt Their ACL Too: Star's Naughty Knee 
One Thing Leads To Another: Why The Second ACL Often Goes Too 
Dog Knee Injuries: Should You Say Yes To Pain Management?
 

4 comments

  1. My dog had surgery. I didn't think there were any other options but should have researched it. His leg didn't fully heal and surgery might not have been the best option for him because it was impossible to keep him still after it. I'll keep this info if I ever face this question again. One thing I learned: you don't have to go with the first option presented to you.

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    Replies
    1. Every vet should present all possible options, and explain the advantages and downside of each. With a few exceptions, there are always options.

      Sorry your dog's legs didn't fully heal. How long since the surgery? Have you done and PT or take other measures to compensate for the results?

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  2. Aw, I'm so sorry to hear about Cookie's knee problem. I'm anxious to hear how the PRP treatment works. I haven't heard of that before and I hope it's successful so you can avoid surgery.

    Haley had the suture CCL repair surgery 12 days ago and seems to be coming along well after going through a minor setback from colitis after the surgery.

    Give Cookie a big hug and I'm sending good thoughts your way. :)

    ReplyDelete
    Replies
    1. Sorry about Haley's knee and post-op colitis. Glad she's getting better. The post-op after the surgery seems very long but every day is a day towards being all better.

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