Thursday, May 10, 2018

More catching up - blame it on the worry

Nobody likes to hear excuses. So I will just begin by offering an apology. This blog has been my sincerest form of love for my Rottweilers. They have made me so filled with pride that I want to tell the world about the joy they have given me every day. But it has been the sorrow associated with their medical problems that has formed a road block in my mind. My mind has been so occupied by the pending crisis with Bessie's torn ACL that I have been unable to write as much as before. I must also admit that I am spending more time on Facebook looking for answers from people who have had this experience and enjoying the comfort of their companionship. Ruffin also has quite a following among Rottie owners as you could imagine.

The more I planned to have the needed surgery on Bess, the more I have learned of the pitfalls. And every pitfall has made me pause and think about how it must be handled. I have been reading a lot of horror stories about how difficult it is to properly care for a large dog following post-op ACL repair and that is my greatest concern.

The problem has many parts. For one, there are several different types of ACL repair but not every canine Orthopedic specialist does all of them. For obvious reasons some surgeons have picked one specialized treatment and stuck with it for many years. This greatly limits the choices of where to have the surgery and by whom. Each type of ACL repair requires expensive specialized tools, hardware and training. The last surgeon I talked to told me she had been doing a certain type of TPLO (tibial plateau leveling osteotomy) for 20 years and didn't want to invest in the high costs of doing the newer procedures.
From what I have been reading there are two basic types of surgery, cutting the bone or drilling holes. The one that involves cutting the top of the leg bone below the knee and either rotating the bone to a new angle then holding it in place with metal plates for about 10 weeks until the bone heals, the other involves cutting and inserting a wedge to spread the cut in the same bone and using metal plates and screws to hold it together for 10 weeks until the bone heals. Both procedures greatly weaken the bone until it has healed and make it prone to failure if the cut is disturbed by violent leg movement. And that is where the horror stories have come up. There have many reports that some of the metal hardware and screws become dislodged or the implants are rejected or become infected and in both cases the surgery must be repeated. In most cases this does not happen and the metal plates are left inside for the life of the dog. But when that problem occurs before the bone has healed the leg becomes useless and must be kept in an immovable cast. The lesser involved procedure uses bands of synthetic material to take the place  of the torn ligament. This is called Lateral Suture Stabilization (LSS) but what I've read is it is for small dogs only.

My main concern with Bess is she is a highly active and excitable girl. She is also very big and very strong and hard to control. Finding a way to keep her immobilized every minute of the day except for potty breaks and doing so for almost 3 months is my greatest concern. I have read where people who were much younger than me put a mattress on the floor and literally slept next to their dogs every night. I would not be able to do this. I have difficulty getting up off the floor now. My most detailed plan involved keeping Bess sedated all day long and even that gave me concerns. How much sedation can she take without creating a problem. And little things like disabling the door bell and putting a sign on the door to keep people from knocking because these things cause Bess to explode into action that I have not been able to stop.

I have written about my Rottie girl Sassy who had both ACLs repaired 12 years ago. She was only 80 lbs or so and had the simpler procedure, the Lateral Suture Stabilization (LSS) which did not involve cutting the bone but three years later she developed so much pain she spent the last 4 years of her life on a very expensive daily pain management routine. And I do not know if the LSS should never had been done because she was too big and that caused it to fail.

Right now Bess has not shown any sign of pain or discomfort. She gets a small dose of pain pills twice a day. In order to limit her movement I read that lowering the dosage of the pain medicine would make her aware of some of the pain and force her to go easy on her activity. So she is getting half the dose that the Vet prescribed and seems quite comfortable. This has not interfered with her moving around and I have begun to think maybe she has gotten used to it. I also think the surgery would not be successful because I cannot guarantee that I could keep her off her leg for such a long time and do not want to create more pain for her than she already has. So that is the conundrum that I face every day.
Everything else has been made ready. I bought Bess an oversized crate that I intended to have her stay in for the long period of recuperation. She has slowly gotten used to it. Ruffin even found his way into the new crate and decided to take a nap one day.
While I am writing about the available options there is one more that should be mentioned. Its called Conservative Management and it basically means doing no surgery at all and lowering the daily activity and possibly that over time the torn ligament will heal by itself. I wish this were true because in a way that is what I am doing right now.
This is just going to have to take longer than I expected.


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