Thursday, November 18, 2010

The Little Hopping Dog Gets a Consultation

Thanks to some generous donations, we finally saved up enough to get Callie an appointment with an orthopedic surgeon.  Yesterday our good friend Ryan took time out of his busy day to drive us all the way out to the DMV Veterinary Center (and back home afterward)!  It was extremely kind of him to shuttle us around and to wait over an hour while we were with the vet, and we sincerely appreciate his help!

Callie had an appointment with Dr. Jérôme Planté, a surgeon at the DMV Veterinary Center in Montreal.  This appointment was a consultation to find out exactly how bad Callie's condition is, as well as her possible treatment options.

  About Dr. Jérôme Planté
Dr. Planté met with us for an entire hour, going over the x-rays of Callie's legs and explaining to us in detail the problems and treatments.  I don't think I have ever had any doctor (people doctor OR vet) spend so much time with me.  He explained every aspect of Callie's condition and treatment, drew us multiple diagrams, and patiently showed us exactly what was wrong with Callie's legs and how he planned to fix them.  If anyone in Montreal ever needs to see a specialist vet, I cannot recommend him highly enough.

So, what did we find out?  For better or worse, it was pretty much what we expected.  Callie has grade 3 patellar luxation, (with grade 1 being the least severe and grade 4 the worst), and her left back leg is in worse shape than her right.  That wasn't a surprise to us, since the left leg is the one she always carries when she "hops"!  The condition in her right leg is a bit strange; although the kneecap isn't where it is supposed to be, the vet said it seems to have adapted and found a way to work anyway.  Since Callie still runs and jumps, he said that for now we can wait on surgery and see what happens over time.

The left leg, however, is in bad shape and requires surgery within the next few months.  The kneecap has become permanently dislocated, so much so that it can't be forced back into place, and as a consequence the cartilage around the kneecap is constantly wearing away as it rubs against the surrounding bone.  The friction between pieces of bone will get more painful for Callie as the damage to the cartilage continues, and as she is increasingly unable to flex and straighten her leg properly.

The surgery itself sounds complicated but really consists of two main steps.  First, the groove in which the kneecap sits on the femur (the top bone) will be made deeper, so that the kneecap has a harder time sliding out and becoming dislocated.  Second, the ligament that attaches the kneecap to the tibia (the lower bone) will be repositioned more centrally, because at the moment it is a bit off to one side (which contributes to the kneecap getting pulled out of place).  Moving the ligament entails cutting off the chunk of protruding bone that it is attached to, positioning that piece of bone in the center of the tibia, and then re-attaching it with several metal "pins."  Probably Dr. Planté will also tighten the joint, to help make sure everything stays in place.

There is always a chance that the operation will need to be more extensive, depending on what he finds when he does a series of x-rays and exams right before the operation.  If things are more severe than he expected, there is also a chance that a ligament will need to be "relaxed," or that a wedge of bone will need to be cut out in order to turn a curved bone into a straight one.

THIS website gives a good explanation of grade 3 patellar luxation and a description of the surgery at the bottom.

And THIS website is a bit more technical, but the diagram of the knee structures is pretty clear, and it provides additional information if you're curious.

The surgery should take several hours, and Callie will stay two nights at the clinic for observation.  When she comes home, her leg will be in a sort of cast, but it is up to us to make sure she does nothing but WALK for two entire months.  If she runs, jumps, or even climbs a stair, it could pop the pins out of the bone and cause HUGE trouble!  She will need pain pills and antibiotics for a couple of weeks, plus something like 5 follow-up appointments and x-rays.  The cost of this all-inclusive package?  $1,500-$2,000, assuming she does NOT need the additional operations I mentioned above (in which case we could expect to easily double the cost).

Obviously, this is a staggering expense, but it is in line with what we expected.  I am still thankful for several things, including but not limited to: 1) We only need to do surgery on one leg at the moment, and not both; 2) we are really confident that the surgery will go well, and with very few risks; and 3) I have complete and utter confidence in Dr. Planté and his expertise.  I know Callie will be in good hands, even though this is such a scary prospect.

At the moment, we are considering our options.  Although Callie doesn't need to go in TOMORROW, we nevertheless need to schedule the surgery within the next few months.  The cartilage can't be repaired and won't grow back, so once it wears away from the kneecap entirely the problem will become much more severe.  We have started giving Callie glucosamine supplements, to help nourish the joint and strengthen the cartilage (in both legs).  Luckily the pills are HUGE and she thinks they are treats, so it's easy to get her to take them every day!  Also, she is still constantly getting spoiled, so she's in pretty good spirits.

In the next few weeks I am hoping to start throwing fundraising events.  We have already had several people volunteer time, goods, and even money to Callie's cause, and hopefully soon I can spread the word even further.  I imagine that we will need to book the surgery sometime in the spring, so that Callie will be all healed in time for the lovely summer weather!  Until then, I will keep everyone posted on our efforts to raise money and Callie's progress between now and the surgery.  And I will of course post more pics and video of the lovely little hopping dog!