Cranial Cruciate Ligament Rupture

[carona]

Aloha,

My name is David. I am a first time dog owner and thought I did all the research I needed prior to purchasing my dog. I belive my 14 month old yellow lab has ruptured her left hinde CCL It happened in mid June. She didn't put any weight on her leg the first day. I took her to the vet and he explained that it may have happened but to let the swelling go down. He also gave her Rimadyl for 10 days. She started walking better but still is stiff after sitting for long periods. I took her back to the vet to follow up after 10 days and he stated the swelling had gone done but re-enforced the possible tearing gave me 10 more daysof Rimadyl. He then just became a business person and talking to me about the options for the money but would never really explain anything to me even when I was trying to ask questions. I got very upset and left. I limited all running and kepted her in a small yard area to limit her activity to give her leg a chance to relax and possibly heal.

I had asked the breeder what they thought and they suggested that it is probably a light tissue tear and to let her rest for a few weeks. We did that. Our dog has all the energy, doesn't whine, favors the leg very little (almost unnoticable). She has gotton away from me in the yard a couple of times and runs like the wind and doesn't show any discomfort. I went to another vet and he did the Drawer Test and showed slight forward movement. He stated immediately that she would need surgury to correct and wrote me up an estimate for $3500-$4000 performing the ACL Intraarticualar procedure.
Wow, it is all about the money. I guess I want a little compassion and details about the procedure instead of an estimate for treatment.

All my reading suggests that I should have the Extraarticualar procedure or TPLO procedure performed and not the Intraarticualar. I feel terrible because I feel as if it is my fault that this happened to her. Did I through the ball one time to many, did the 3 stairs she walks up and down cause it?. I am scheduled to get another lab from the same breeder and feel aweful getting another puppy when my current one needs me the most.

So now my questions:
1. Does or can anyone recommend a repitibule orthopedic vet on the island of Oahu. My vet doesn't do it and the one they recommended to (whom I saw above yesterday) doesn't give me confidence.

2. From the reading I should have the MRI done prior to surgury. The vet who suggested the surgury didn't even suggest that. Since the Drawer Test is complete and surgury recommended is MRI next?

3. With recovory, do I need to be home all day? Can you leave your dog alone for up to 7 hours?

In a nutshell, my guilt is getting the better of me and I don't know what to do. Any advice would be greatly appreciated.

David

[Daveyo]

Ok first of all the best place to get started is do some investigation concerning your dog. Secondly put a tight elastic band around the affected leg to prevent further damage. Important here.

Third, go to a University Animal Hospital clinic and get an X-ray and an MRI done on your dog.

Fourth what the doctor needs to do is give a small injection to get the dog relaxed and sleeping for about 10-15 minutes. While the dog is relaxed and sleeping then the doctor can move the affected area to see where if it has slipped and its motions etc.

Once finished put the elastic back on and wait till the dog wakes up.

Based on the X-ray and the MRI and the physical exam on the movements, then let the Doctor determine if there is damage and if so how much damage and what it will take to fix it.

Then if surgery is needed, then find somebody who can do micro surgery to fix just the specific tear area, and not damage the rest of the important muscles etc. Once you find that specialist, then ask for the cost factors etc.

I strongly suggest first you get dog insurance now. Do this first. If you got the dog covered under some insurance then you can escape the huge fees. However don't do anything yet at least 30 days from the effective coverage just so your inside the window. Then you can get a doctor to make the declaration etc. Be smart here ok

Be wary of fast track VETS who think nothing of money as you already found this out.

The only ones I know that are specialists is in Houston of which there is a good clinic with probably the type of doctors who are experienced in this field.

Keep in mind there is a huge debate ongoing between the two different surgical techniques. What may work for one dog may not work for the other dog.

Tough choices coming up for you, so examine each surgical method carefully and do some studying. Choose the one with the higher success rate overall for recovery and of minimum problems after such surgery. That would be the one I would choose if I were you.

This is the best I can tell you.

Daveyo

[Daveyo]

Ok here are some links for you to read and to study up and get to know what your dealing with. It is quite informative. Also you can read up on the alternate method called the wait and see type and it depends on the severity of the damage. If it is barely minimal, then do the wait and see and follow those instructions. If it improves and the dog recovers, then your in luck.

Here it is.

Extracapsular Stabilization Method

http://www.cvmbs.colostate.edu/ivapm/professionals/members/current_articles/budsberg.htm
http://scholar.lib.vt.edu/theses/available/etd-04302003-201619/
http://www.ejbjs.org/cgi/content/abstract/86/5/988

Tibial Plateau Leveling Osteolomy (TPLO).

http://vetsurgerycentral.com/tplo.htm
http://www.fvarc.com/PAGES/ARTICLES/images/fall-2004.pdf


You need to have an MRI done on the dog besides an X-ray to determine just exactly what got

damaged. From there you can determine the best method of treatment. Both methods are OK but

the second one is lesser chance of arthritis. That is about the only plus that it has over

the other one.



I have a link for you to read which is good for lay people to understand about these

ruptures. First there are 4 named ligaments in a human being and there are only two named

ligaments on Dogs. Funny how I can say this but it is true.

Here is the link http://www.marvistavet.com/html/body_ruptured_anterior_cruciate_lig.html

Alternate method called the wait and see method.
http://home.earthlink.net/~tiggerpoz/index.html


Good luck with it

Daveyo

[carona]

Daveyo,

Thank you very much for both responses. I am beginning to become more educated and will take on board your advice. I am looking for a qualified orthopedic vet in the Honolulu area since that is where I live. I don't believe the University of Hawaii has services but there are a number of other options. I will begin calling today and hopefully get some consultations setup.

If you don't mind, I will keep the forum up to date on the process. Someone may get something out of what I find out.

Aloha,
David

[Daveyo]

Sure sounds good. Keep us posted up to date especially the state of Hawaii!!!!!!

Out in the middle of water, sure needs some resources there.


Daveyo

[MastaLucious]

Hi David, my name is Chase. Sadly, I too am going through exactly what you are. I live in Honolulu and my 2yr 10mo old terrier has ruptured both cruciate ligaments. Like yourself, I was quoted at roughly $4,500-$5,000 per leg. I'm sure that it would actually be slightly less if I did a bi-lateral TPLO, but that is still in the vicinity of $10,000. This I don't have and I am being absolutely crushed everytime I look at her. My father is a veterinarian in California and he has been helping to provide my wife and I with advice for a while now. Here is all the investigative work that I have turned up in Oahu: There is only one BOARD CERTIFIED orthopedic surgeon on island. He travels from hospital to hospital as needed. He is the individual that I was quoted for. I currently go to the Pearl City VCA hospital. Now to clarify. A board certified orthopedic surgeon only means that this particular DVM has undergone so many orthopedic surgeries and qualifications that he became eligible to sit for a board. The board convenes and determines if the individual is qualified enough to be designated as an orthopedic veterinarian. Just because somebody hasn't sat board doesn't mean that they aren't capable and qualified to perform the surgery, it just means that there is a difference in credentials. (Johnny Cochran vice my cousin Vinnie). I know that it sounds terrible and that nobody likes the thought of shopping around for a family members health, but you must not think about it that way. You cannot blame yourself for this injury or the cost of the procedure. We have done wonderful things by bringing these pets into our lives and there is no way to predict these things. Yes you could have thrown the ball one less time, or avoided stairs, but then it may have happened while out walking and you may have had to carry/walk your dog back the entire way. What's important is that we figure out what can be done about it. Let me give you a little bit of a background on my particular situation.
Last month, we were in our back yard throwing the ball around. My puppy dog is about 64 lbs and pure muscle. She is the sweetest thing and can run faster than almost any dog at the park. I've known for a while that she had the potential for ligament issues, but I vowed that I would never push her and try to minimize strenuous activity. She used to limp after a hard days work at the park or hiking. Just because an animal limps on one leg, doesn't mean that there isn't a problem with the other. It just means that one hurts more than the other. When she returned the ball to me, she wasn't limping, she wouldn't even put weight on it. I brought her in and forked over the $480 to have her examined. She was sedated and had radiographs done in a ventral/dorsal view along with a stifle view. The X-rays revealed mild hip displaysia but no stifle joint problems. X-rays do not show soft tissue (Ligaments/Tendons/Cartilage). So the vet performed a drawer test while sedated and was about 90% confident that it was a ruptured CCL. We put her on 1/2 tablet Previcox daily, 75 mg Tramadol three times daily, as well as Promotion dietary supplement (glucosomine with anti-oxidents) twice daily. We continued this regimen for about a month until we realized that she could barely get up. I performed the drawer test myself and was relatively confident that this was another ruptured cruciate ligament since she had a predisposition. This one ruptured as a result of her putting all her rear weight on just one leg. At this point in time, we had no idea where to turn since we couldn't currently afford one TPLO let alone two. After severe deliberation, I made an extremely difficult decision. Backed into a corner, I felt that the best decision in her interest would be to end her suffering. She is my best friend and a family member and if I had the resources, I'd do anything necessary, but I didn't and we were out of alternatives. We brought her in on Friday for euthanasia. I signed the paperwork and tried to keep my composure, but was unsuccessful. Just as the vet walked in, she told me that she wanted to exhaust every last opportunity. I agreed that this would be something that I would like to do, but I didn't want to drag it out and let her suffer. I told them that I would give them a couple of weeks to find something that I could work with. Later that evening, I got a call back saying that one of there vets at the Kailua VCA hospital has performed extracapsular repairs (suture method) on dogs larger than mine that had been successful in the past. He quoted me for the surgery which would be done one leg at a time for about $1,700-$2,000 each. I consulted my father in California and he advised against it due to my puppy dogs physique. As I drove home feeling pretty hopeless, I suddenly remembered something that I saw on the news a while ago. Upon further investigation, I have realized that this is a pretty good alternative that would be able to buy me and my dog the time necessary for me to come up with the funds for a bi-lateral TPLO. Canine wheelchairs. Take a look at the following link:
http://www.doggon.com/home.html
The success of these are pretty phenominal as well as the quality of life that they can return to our friends. I am hoping to buy ours within the next couple of weeks when we have the money. Please let me know what you find out. It's good to have somebody to contact about this in the same vicinity. You or anyone else in a similar situation may email me at any time at [moderator note: e-mail address has been removed]. I would even be more than willing to give you my phone number in an email if you have any questions that you need answered or want to compare ideas. Who knows, maybe we can get a discount for wholesale. Good luck David and I hope to hear from you,
Chase

[Daveyo]

Hi Chase

Not a bad idea to buy yourself some time in providing the op for your dog. Since your parents are in California, why not have him help you locating a VET who specializes doing such. I am sure your father can make out some kind of deal here between two VETS on the private side. There is also the possiblilty of getting a credit deal here too as well.

You can make payments you know. Up to you.

The key to all this is DOG INSURANCE. I cannot stress this enough. The bills today is so high you need that insurance to back yourself up in case something drastic happens.

Yet many of us cannot afford this kind of insurance. Why because of the structure that is set up.

So best for most folks is to put away like a 100-200 a month aside to build up medical coverage for your animals. In the meantime you have this cart, well if you can pull it off do one leg at a time.

I prefer the micro surgery which is less invasive and probably better but again the cost is there.

Ligaments are like rubber bands. Once they snap very hard to put back without it tearing the other part. Try it yourself. Break a large wide rubber band, or cut it. Then sew it and see what happens stretching it as you sew it. This is what the VET has to deal with when fixing this kind of repair.

Hope this explains it a bit better

Currently there is no synthetic means to be able to duplicate a ligament without the body rejection process taking place but I will look into something that I have an idea but it is a wild one. I will think on it a bit and let you know. I am thinking along the lines of stem cells- hmmmm that can somehow regenerate a new ligament and repair the damage one somehow. Just a thought so I will think on it.

Daveyo

[MastaLucious]

Thanks Daveyo. We are currently looking into Critter Credit and any other means possible. The only problem I see with the pet insurance is that the condition has already presented itself. Should I try and make a claim on a bi-lateral tibial plateau leveling osteotomy, the insurance company would be pretty suspicious. I have spoke with my parents and we have looked into the option of flying our dog back to California to do the operation and that proved to be much more expensive. Currently there is only one board certified orthopedic DVM on the island of Oahu, but we are still looking for doctors that may have the experience but have just never sat board.
The irony of all this is that the surgery our dog needs, TPLO, I have had done three times in the past 1 1/2 years. I completely agree with your description of ligaments. I myself have torn my medial collateral ligament, stretched out my ACL, tore my meniscus, and fractured my tibial plateau in a snowboarding injury several years ago. I sympathise with what she is going through and know what's to come should we perform the operation. Sadly, the TPLO is really the only option with a good chance of success for a dog of her size. Because of her strength and weight, any other type of operation would result in a high chance of catastrophic failure. The idea of using stem cells is a good one, but complications arise with the following:
The leg would need to be immobilized for a significant period of time. This causes the surrounding muscles to atrophy significantly. Should the concept work and restore the connective tissue, the recovery my prove to be just as damaging. This is because unlike us, dogs don't understand the concept of physical therapy. Therefore, they go and go until it hurts. If the muscles are deteriorated and a canine pushes itself, it may severly damage the newly implemented ligament.
Secondly, when ligaments naturally form, they are growing with the body at a relative rate. This allows the proper tension and length to be developed. Should you inject stem cells into an adult dog with an immobilized leg, the stem cells will bridge the gap between the ruptured ligament and the condyle of the bone it's reconnecting to. Furthermore, you would need to hope that the ligament restores its connection to the original location. If this procedure did indeed succeed in reconnecting the ligament, it would be longer than the original. This could potentially negate the goal of the entire procedure.
Good thinking though and keep those thoughts running through your head... That's how the artificial heart was created.
Thanks,
Chase

[Daveyo]

Should you inject stem cells into an adult dog with an immobilized leg, the stem cells will bridge the gap between the ruptured ligament and the condyle of the bone it's reconnecting to. Furthermore, you would need to hope that the ligament restores its connection to the original location. If this procedure did indeed succeed in reconnecting the ligament, it would be longer than the original. This could potentially negate the goal of the entire procedure.

Chase pay attention here

The surgery would still have to be performed regardless to at least get the connections to near contact between both tear sides. ][ < In a sense you can see this itself but the gap between both of them is much closer. Now the stem cells is injected to both ends near where the tear is at. These cells will then pick up the muscle cells and it will then try to bridge the tiny gap between them similar to welding two pieces of steel. Get the drift.

The sutures of course is dissolvable and it will go away. Yes you will have a small scar involved here but the gap is sealed up with new muscles similar to the weld of two steel plates. In fact that tear area is now twice as strong. The weak part will be the area not torn. Again similar to the steel weld concept.

Muscle atrophy will be minimal, and just like anything else you have to control the animal with the cart means once the immobilized leg is fully healed then you can proceed with phase two of the recovery. You let the dog have very little weight on it in the beginning, and also do what they do for polio victims. Let the dog exercise in a pool area suspended up just off the bottom part of the pool. Here the dog can practice moving the legs to build up strength.

Now after the dog is fully healed and before you let it walk on it full tilt, make sure you have the MRI done on it to be certain it is fully healed. If so, then put a collar on that dog and hold it by the leash.

You control the dog and you can pace it slowly around as it rebuilds the leg muscles. You have to also understand the days of running around for this dog is OVER. You do not let it run around again, or go up and down the stairs or try to take leaps or you will face that problem of a possible tear.

Your right a dog is a dog and they like to run when given the chance, so it is up to you to CONTROL the dog and prevent it from running around or going to areas that you restricted such as stairs or steps.

Dogs do put a lot of thrust especially in the rear legs to propel themselves forward, and under normal circumstance a basic walk will be just fine exercise wise. Anything above that your asking for possible trouble.

You will be quite surprised to see how fast stem cells can heal, once it obtains the snapshot codes in the DNA from the other muscle cells.

Again this is only a concept idea, and none has been done before so maybe it worth mentioning to your father since there is a person who does administer stem cells, and has a practice in California but does this outside of USA in Bermuda. Reason is USA has restrictions. Your father can do this for you privately himself since it is purely family and not in it for the business aspects.

How successful, well, this doctor has had patients completely paralyzed and quadraplegics etc, and they recovered and were able to walk again and do things again. Any wonder how good stem cells can be, which I think is the next new generation of surgical repair for damage organs and perhaps bones, and even repair brain damage. The possibilities is endless.

One of those possibilities is cloning an exact replica of you yourself. Now this part I do object and I certainly don't want another person looking just like me walking around. However for the purposes of food production to survive I can allow it be it for a chicken, steer, cow to make milk, or pigs etc. This for me is OK. Making another new heart or lungs or kidneys or liver, or stomach and other major parts such as ears, or eyes or brain repairs for the matter I can approve this too. Any further than this NO. Will this extend your lifespan probably so, how long unknown. We still will age no matter what and eventually Death will catch up on us sooner or later. Nothing is forever. The possibility of being able to reach 100 years old can be maybe the norm for the worlds population. I don't know, but again food production has to increase to feed more people because we are living longer and death is not happening as fast.

I won't be around to see this take place so this idea is just a toss in the winds.

Daveyo

[MastaLucious]

I think that you underestimate the level of difficulty in coercing a dog to only put small amounts of weight on it's leg. Yes, you can use a cart to limit the weight on the leg to a degree or even perform aqua therapy, but how often do you put a dog in the water and tell them to "stroke gently". You may also want to check your resources if you think that atrophy would be minimal. I will assure you from first hand experience that it doesn't take a lot of time to atrophy when immobilized.
You state
"These cells will then pick up the muscle cells and it will then try to bridge the tiny gap between them similar to welding two pieces of steel. Get the drift."
No, I don't get the drift. What are we talking about here, muscle cells or the ligaments? The CCL is pretty small and even if there is a small gap bridged, it is enough to lengthen the ligament.
Your description of the recovery sounds like it is taylored for an owner who doesn't have to work let alone leave the house. The time involved with recovery as well as the complexity is enough to be a full time job itself. Finally, the quality of life that might be restored sounds like it falls far below that of the TPLO. The TPLO may cost twice as much as the extracapsular repair (not including stem cells and 1st class flight to Bermuda), but the success rate is much higher for this size canine.
I agree that stem cells are quite amazing and I fully support further study of their capabilities. I think that they have some of their most profound effects on nerve related illnesses (paralysis), but I don't think that they are the solution to certain complications. Hell, I wouldn't even mind having another one of me walking around. Just another handsome individual to admire.
I really do hope that there is better solution out there and if they determine that stem cells is the way to go, I will be the first to admit that I was wrong, but I find myself skeptical with the use of stem cells for this type of injury.
Who knows, maybe some day we will weld our buildings together with stem cells...