VetInfo Digest            June 2003

Surgery Issue:

Surgery in Veterinary Medicine

Routine Surgeries

Emergency Surgeries

Alternatives to Some Surgeries

 

This Month's Note:

There is an old joke about a man walking around the city banging two sticks together. When asked why, he replies "I'm keeping elephants away." When told that there aren't any elephants in the city, the man replies "See, it's working!"

I feel a little like I'm talking to this man when I ask veterinarians about the results they get when they attempt to stabilize a dog's stifle joint after cranial cruciate ligament ruptures occur. Most veterinarians strongly advise surgery. Most dogs who have surgery eventually walk pretty well. However, most dogs who don't have surgery eventually walk pretty well, too. Most dogs who don't have surgery develop arthritis in the knee over the years and require medical treatment for the discomfort as they age. Most dogs who have surgery develop arthritis and require medical therapy for the discomfort at some point, as well. As near as I can tell after observing a great many of these patients, there isn't much difference between surgically stabilized knees and knees that are allowed to heal on their own without cranial cruciate ligament surgery. Some dogs in both groups do worse than expected and require more attention. Every time one of these dogs hasn't had surgery a surgeon is quick to say "Think how much better this dog would be if surgery had been performed." When things go bad, though, few surgeons ever say, "Think how much better this patient would have been if I hadn't done surgery." Instead, they say "Well it would have been worse if we hadn't tried." It is hard to be a surgeon without being able to tell yourself things like that when surgeries don't work well. Unfortunately, even though I sometimes say it too, I think that statement is the veterinary equivalent of beating sticks together to keep the elephants away -- it is very hard to prove that it isn't true but just a little bit of common sense makes a person suspicious.

 

Surgery in Veterinary Medicine

Differences in training and practices between veterinarians and human physicians may be most pronounced in the area of surgery. Most veterinarians do not go through internships and residencies prior to going into general practice. This means that veterinarians do a great deal of surgery in practice on a "learn as you go" basis. This is not necessarily bad, especially if a more experienced veterinarian works at the practice and can pass along insights and techniques that have been successful in the past. It can be a very bad situation in some cases, though. There is absolutely nothing that prevents a veterinarian from trying brain surgery or any other new surgical procedure for the first time on a patient in their practice, with no input from anyone who has done the surgical procedure before.

It is possible to get advanced training in surgery in a manner quite similar to the way that human surgeons are trained. Internships at veterinary schools and larger referral centers are available. Residencies are also available for veterinarians who want to become surgical specialists. The American College of Veterinary Surgeons (AVCS) provides board certification for surgical specialists who have at least four years of surgical training after veterinary school and who pass a qualifying examination. There are about 950 members of the ACVS, making it possible to seek the services of a surgical specialist within a reasonable driving distance over much of the United States.

Veterinarians who do not have board certification are not supposed to refer to themselves as specialists based on most state practice acts. A veterinarian is free to restrict his or her practice to surgery without pursuing board certification and it is likely that most veterinarians who do this are competent surgeons. Their practice advertisement usually says something like "practice restricted to surgery" but not "Diplomate, ACVS".

Since it is possible for a veterinarian to decide to do any surgical procedure, regardless of previous experience or training, it is a good idea to ask your veterinarian how many times he or she has done a particular procedure prior to authorizing it. I think it is reasonable to ask this question in any circumstance but it makes more sense to ask about experience with a difficult orthopedic surgery than a spay or neuter procedure, for instance.

I am not going to cover anesthesia unless it is particularly relevant to a surgical procedure, but it is always a good idea to ask your veterinarian how a patient is monitored during anesthetic procedures and to opt for having an anesthetist, especially during long procedures, if possible. A certified or licensed veterinary technician may be the person who usually monitors anesthesia in a veterinary practice and this is acceptable, especially if a technician is dedicated to the task of monitoring an individual patient throughout a surgical procedure.

Deciding whether to allow your veterinarian to perform a particular surgery for the first time on your pet can be a difficult decision. In rural areas it may be the only choice, especially in urgent or emergency situations. In most suburban and urban areas it is possible to seek a more experienced surgeon and in general this is a better idea. Your veterinarian should be willing to refer your pet to a surgical specialist if requested, for any surgical procedure. Remember that this is not always a good idea --- the odds are high that a general practitioner has much more experience with routine procedures such as spays and neuters and may actually be a better choice for these procedures.

Veterinary surgeons are often called upon to do both soft tissue and orthopedic surgeries on a regular basis. There are some veterinary surgeons who specialize even further and only pursue one surgical discipline, such as orthopedic surgery, soft tissue surgery , cancer surgery or brain surgery. For truly unusual surgical situations it can be worth locating a board certified surgeon who further specializes in the type of surgery your pet requires. This is especially true for cancer surgery when dealing with highly malignant tumors such as the vaccine associated sarcomas that occur in cats.

For some reason, surgical procedures tend to be examined less rigorously than medical procedures. There are not as many really good studies comparing surgical techniques and comparing the outcome of no surgery versus surgery as there are good double blind studies of pharmaceutical or medical procedures. To some extent, surgeons are locked into the mentality that the results of their endeavors can be seen immediately and require no further reflection. This produces a situation in which there is wide general agreement on the benefits of some surgical procedures which turn out to have little benefit when carefully examined on a more scientific basis.

It is likely that most veterinary hospitals are not staffed 24 hours a day. For these veterinary facilities, the practice of hospitalizing patients after surgery is a little suspect , since there may be no one watching the pets who are there during the night. When your pet has surgery and the veterinarian asks you to leave your pet overnight it is best to ask if pets in the hospital have 24 hour a day care. If not, then it may make more sense to take your pet home the day of the surgery, even for fairly extensive surgeries. We have sent our surgical patients home on the day of surgery for the past 23 years for most procedures without any significant problems.

The arguments for hospitalization after surgery even at veterinary practices in which no one watches the pet all night usually include ensuring that a pet is not active after surgery, ensuring that food is not given too soon after surgery and the opportunity to reexamine the pet the next day to ensure that there are no complications prior to sending the pet home. The arguments for sending the pet home are a decreased potential for hospital acquired infections, observation of the pet by the pet owner, who can then presumable contact their vet or an emergency veterinary clinic if problems arise, better pain control since owners can administer necessary pain relief medications and decreased patient stress due to being in its home environment. We have sent almost all of our surgery patients home, even after extensive surgeries such as removal of intestinal foreign bodies or cesarean sections, for over 20 years, without a single significant complication that we believed would not have occurred if the pet had stayed at our clinic overnight.

When we believe that a pet will need 24 hour care after surgery and it is not possible to refer the pet to a facility that offers 24 hour care for the surgery, there are some other options. We ask our clients to take their pet to the local emergency clinic (EVC) overnight and to bring their pet back to the clinic in the morning in this circumstance. The EVC is equipped and staffed to handle critical care situations, if the need should arise. Some veterinarians will take pets to their own home for observation in this situation, or make scheduled checks on pets during the night. In our area, there is a certified veterinary technician who will come to our clinic and stay all night if the pet owner is willing to pay for her services. Knowing what arrangements are expected and what services are available could make a big difference in your pet's care.

Patients who have surgery are very likely to have some pain associated with the procedure. There are exceptions to this rule but it is generally better to error on the side of pain relief when there is any question. Veterinarians are getting better about providing pain relief medications but there are still a large number of vets who do not routinely dispense or use pain relief medications for standard surgical procedures such as spay or neuter surgeries. Spaying is an ovariohysterectomy. This is a major surgical procedure and pain relief medication should be given to dogs who have been spayed. It is also a major surgery in cats but pain relief medications for cats are not as readily available, so we tend to rely on injectable pain relief medications at the time of surgery and not to dispense oral medications to follow up with. I am hopeful that we will have a good option for continuing pain relief in cats soon.

For orthopedic surgeries pain relief should always be part of the post-surgical care. Knee surgery and hip surgery are just as painful for pets as they are for humans. In general, anticipating the level of pain associated with a surgery based on the amount of pain that a similar surgery would cause in a person is a good way to decide how much pain relief medication to use. It will not always be possible to find someone with firsthand experience of a particular surgical procedure but usually it is possible to infer the degree of expected pain from similar procedures.

There are now a number of very good pain relief medications for use in dogs. Carprofen (Rimadyl Rx) and deracoxib (Deramaxx Rx) are non-steroidal anti-inflammatory medications approved for post-surgical pain relief in dogs. Narcotic medications, such as morphine or fentanyl patches (Duragesic Rx) can provide additional pain relief when necessary. Cats are not as fortunate, with no non-steroidal anti-inflammatory medications approved for post-surgical use in cats in the U.S. Meloxicam (Metacam Rx) is approved for use for cats in many countries but not in the U.S. There is a human form of this medication, (Mobic, Rx), which can be used, although this usually requires using a compounding pharmacy to get the medication into a usable form for dosing. Cats do seem to respond well to low doses of morphine and to the fentanyl patches when longer term pain relief is necessary.

Presurgical lab work is often recommended prior to surgery. This is something that many vets feel passionate about, but which also leads to some bad decision making in veterinary medicine. I know of a number of situations in which veterinarians suggested presurgical lab work and found themselves in a real bind when a surgical procedure was necessary but the lab work indicated that there was another preexisting problem. I have been involved in cases in which veterinarians attempted to postpone important surgical procedures based on lab results showing another problem, partially because they had sold the lab procedure using the reasoning that it might show other problems. This can be a very serious error, if the surgery is necessary. As long as reasonable choices are made with the information obtained, it seems reasonable to do lab work since it isn't harmful by itself and knowledge of other conditions present can help in decision making, including developing a realistic prognosis. When a preexisting problem is found it is often better to go ahead with surgery and deal with the newly discovered problem after the surgery is over.

If you do opt for presurgical lab work, make sure that it is done properly. My mother had surgery several years ago and had a presurgical blood panel drawn before she went for surgery. The lab results were reported to the doctor after the surgery was over with. There is no good excuse for this, in my opinion. If the presurgical panel was important to the doctor, or to my mother, it should have been run and the results analyzed prior to the surgical procedure. What is the point, otherwise?

For most surgeries, the goal is to produce a cure for the problem that the pet is suffering from. Removing an intestinal foreign body or bladder stones are examples of this type of surgery. Almost as commonly, surgeries are done to try to prevent problems. Spay (ovariohysterectomies) and neuter procedures are examples of this. Another category of surgeries are those done to relieve pain or suffering, without providing a cure. These are referred to as "palliative surgeries" and include procedures such an amputation to control pain from bone cancer or after a severe injury to the leg that can not be repaired. While palliative surgeries do not provide a cure, they can provide an increase in the quality of life, a worthwhile goal in itself. It can be beneficial to control pain even if a pet will only live for a few months to a year after surgery, for instance.

We occasionally get requests to describe specific surgical procedures and to discuss the necessary presurgical evaluation and post-surgical care. For the remainder of the newsletter I'm going to try to give a brief description of some of the more common surgical procedures and any special precautions or care that should accompany the procedure.

 

Ovariohysterectomy (OHE)

A spay is an ovariohysterectomy. The "ovario" portion refers to removal of the ovaries and the "hyster" to the uterus. Some of our clients ask us why it is necessary to remove both the uterus and the ovaries, since it is not uncommon in humans to remove one or the other. In dogs, removal of the ovaries is necessary to stop the estrus, or heat periods. Removal of the uterus is necessary because uterine infections can occur in dogs even after removal of the ovaries and these infections are often life threatening. In cats, uterine infections are less common but are still enough of a concern that most veterinarians feel it is best to remove the uterus in cats, too.

There are advantages and disadvantages to spaying female dogs. The two major advantages are an almost total reduction in mammary cancer in dogs and cats spayed before the first heat period and an almost complete elimination of uterine infections, as well. It is estimated that about 25% of unspayed female dogs will develop mammary cancer. If a bitch is spayed before the first heat period the expected future rate of mammary cancer is less than 1%. If she is spayed between the first and second heat periods it is estimated that the mammary cancer rate can be expected to be about 8% and there is no significant change in the risk if a dog is spayed anytime after the 2nd heat period. In cats, there is a similar reduction in the mammary cancer rate but the only known statistic is for spaying prior to the first heat, since cats tend to have many more estrous cycles than dogs.

The disadvantages for spaying include premature urinary incontinence in dogs prone to incontinence due to estrogen deficiency, an increased tendency to develop osteosarcoma (a form of bone cancer), weight gain above the expected normal for about 10 to 20% of spayed females and aggravation of preexisting aggressive tendencies in some female dogs. Anytime that surgery utilizing general anesthesia is attempted, there is a risk of injury or death due to anesthesia, as well. The current estimate of the probability of a death associated with general anesthesia in dogs is 0.1%, or 1 in 1000 surgeries. This rate probably varies widely from one veterinary practice to another. Osteosarcoma is most prevalent in the large and giant breeds of dogs. With the possible exception of rottweilers, mammary cancer rates are higher than the rates of osteosarcoma by a considerable margin, making this a less important concern than it might be otherwise.

Spaying is a major surgical procedure. Pain relief medication should be dispensed for female dogs post-surgically and at least considered for cats, even though medications are not as widely available for pain relief in cats. In several other countries carprofen is available as an injection that can be used to provide post-surgical pain control and meloxicam is available in oral form for control of pain in cats but these medications are not yet available in the U.S.

Spaying is so widely practiced in the United States that having a female dog who is not spayed is unusual. This actually presents a small risk that disorders associated with intact females will be missed by a veterinarian who simply assumes that a female dog will have been spayed. If you have an intact female dog it is critically important to remind your vet that your dog is intact if she ever becomes ill, especially if she is drinking more and urinating more, even if there is no visible vaginal discharge. Uterine infections often have no clinical signs in dogs other than increased drinking and urinating and lethargy or depression.

 

Neutering

While technically the term neutering can be used for both female and male dogs, it is more commonly used in the U.S. when referring to male dogs. Probably because saying the word castration makes most men cringe. Neutering is a relatively minor surgical procedure other than the need for general anesthesia, unless one of the testicles is retained in the abdomen. Pain relief is still a good idea but is probably only a necessity the day of surgery in males.

Neutering decreases aggression in some dogs but can not be counted on to produce this effect. It eliminates the possibility of testicular cancer and it cuts down dramatically on the rate of prostate disease later in life. Male dogs who are neutered are less likely to urine mark, less likely to disappear for days in search of females in heat and they suffer less injuries related to mating behaviors in dogs, such as bite wounds, being shot by irate female dog owners and getting hit by cars in their travels. There is much less chance of perianal adenoma (tumors around the rectum) in neutered male dogs. No one at our practice can recall a significant personality change associated with neutering. Neutering early can lead to a larger body size than would have occurred in an intact male dog. This can be an important problem in toy and small breed dogs if an owner wishes to keep a neutered dog within breed standards, for some reason.

 

Declawing

Cats are frequently declawed in the U.S. Usually only the front claws are removed. This procedure is controversial in many aspects. When cats are declawed the last bone in the toe is removed with the nail. This would be roughly the equivalent of removing a finger at the joint just below the nail. To some extent, the sheath covering the toe, which is unique to cats, provides protection for the surgery site, but there is no question that this procedure is painful for several days after surgery. There has been a lot of hype about laser surgery making this procedure less painful but two separate independent studies have failed to confirm this except for the immediate (same day) post-surgical period. All cats undergoing this procedure should receive pain relief medications for several days after surgery. Although we do not perform declaw procedures at the present time in our practice, we have in the past. We had the best luck with pain relief using morphine the day of the surgery and the next day, but many veterinarians like to use fentanyl (Duragesic Rx) pain patches or use butorphanol. In cats, butorphanol provides a fairly short period of pain relief, probably averaging about 2 hours, so it has to be given frequently for good effect.

I know that declawing can seem hard to justify, considering the pain involved and the amputation of a portion of the toe. However, from a realistic standpoint, there are many cats who would not have homes if they were not declawed. In addition, many cats have much better relationships with their owners when they are declawed. Therefore, I find it hard to condemn this procedure entirely, even though I would prefer that people think about whether a cat is the right pet for them and base this decision on having a cat who has its claws, prior to obtaining a cat.

Cats who are declawed on the front feet only can usually still climb trees and have normal mobility. Most of them can still catch birds and other small animals, even though this is a behavior that some of their owners are trying to control through declawing. I think that it is reasonable to let declawed cats outside without fearing too much for their safety. I believe that cats get away from larger predators using their brains rather than their claws, in most cases. Being declawed causes more problems with other cats than with dogs, because cats do threaten each other with claw swipes and it doesn't seem to take long for cats to figure out who is declawed and who isn't when they are fighting with each other.

 

Emergency Surgeries

Eye surgery

There are a number of fairly routine eye surgery, or eyelid surgeries, performed in veterinary hospitals. There are a few things to remember about eye surgeries. The first and most important thing to remember is that time is critical when the eye is severely damaged. It is often possible to save an eye even after it has been punctured and collapsed, if an ophthalmologist, or veterinarian familiar with eye surgery, can be found within 4 hours. After this time period it becomes much less likely that the eye can be saved.

If an eye pops out of the socket this is also a true emergency, if conserving vision is a goal. The optimal time to replace an eye into the socket is immediately and every minute of delay after that increases the risk for loss of vision or even loss of the eye. Returning the eye to the socket does not require special skill and a general practitioner should be able to handle the task. The post-surgical period often requires extraordinary patience on the part of the veterinarian and the pet owner. The eyelids are sutured over the eye to protect it while the area around the socket is swollen. It can take a month or more for the swelling to recede to the point that it is safe to remove the sutures. The primary problem with swelling is that the eyelids can not completely close in some dogs until the swelling is completely resolved. If the sutures are removed too early this can lead to serious corneal damage and loss of vision, even after successful replacement of the eye and good post-surgical care up to the point the sutures are removed.

Cataract surgery is commonly performed in dogs by veterinary ophthalmologists. There is roughly a ten percent complication rate for cataract surgery, so it is important to plan for this possibility. If cataract surgery is performed it is best to do it at a time when daily return visits to the specialist can be made, if necessary -- even though 90% of the time this won't be necessary. If you have to travel far to get to a veterinary ophthalmologist it is especially important to plan for this possibility.

Eyelid tumors are common in older dogs. These are often benign and may not cause much problem. There are some tumors that occasionally affect eyelids that are malignancies, though. If it is not clear that a tumor is benign, removal is probably best. It is only possible to remove about 25% of the eyelid margin without having to do some sort of reconstructive surgery to enable the lids to do their job of protecting the eyes. Therefore, it is critical to remove eyelid tumors before they occupy more than 20% of the lid margin. This allows a little room around the tumor to make a wedge shaped incision to make sure that the entire tumor is removed.

 

Gastric dilatation-volvulus (GDV, Bloat)

Gastric dilatation (bloating) is overfilling of the stomach with air, froth, liquid or in puppies (usually) food. Gastric dilatation alone does not necessarily require surgical intervention, especially in puppies. Volvulus (rotation of the stomach) is a secondary problem that accompanies bloat. When the stomach gets bloated and heavy it can twist on its own axis, which cuts off the blood supply to a portion of the stomach. This is an absolute emergency. When a pet (this is very rare in cats) has bloat, they are usually very uncomfortable, may try to retch or vomit unsuccessfully and the abdomen is or will become so distended that it is wider than the rib cage. A sudden onset of bloat should be treated as an emergency, as dogs can die from this condition very quickly, sometimes within two hours after the initial signs.

In the past there has been some disagreement about the best way to treat patients with GDV. There was a push to try to stabilize these patients "completely" prior to surgery. Based on the experiences with bloat at our practice, it is much better to proceed as quickly as possible to surgery after initial stabilization efforts, which include placing intravenous catheters to allow rapid fluid therapy and at least partially relieving the bloating by passing a stomach tube or using a needle placed into the stomach from the body wall to drain off gas and froth. As quickly as possible after accomplishing these tasks, surgical exploration of the abdominal cavity should be performed to correct twisting of the stomach or to ensure that it not twisted. In either case, a gastropexy, or fixation of the pylorus of the stomach to the body wall to prevent twisting in the future, should be performed. If a portion of the stomach has been severely damaged it may be necessary to oversew this (enclose it in a fold of normal tissue) or to remove the damaged area. Even with quick surgery there is about a 10 to 20% chance that a dog with GDV will die during surgery or in the day or two following surgery. Untreated, though, most dogs with severe bloat and probably all dogs with dilatation and volvulus, will die.

 

Spinal disc surgery

Several breeds of dogs are prone to spinal disc problems, especially dachshunds. The one major point that has to be stressed about spinal disc surgery is that it must be done very quickly after the onset of paralysis or weakness related to disc problems. I try to tell every dachshund owner that they need to have a plan to come up with $2500 overnight, should a spinal disc problem occur. There is no good alternative to surgery for this condition. When performed within 24 hours of the onset of paralysis or weakness that is due to spinal disc disease, surgery works very well. After 24 to 48 hours the success rate for surgery drops off dramatically. In most cases, a general veterinary practitioner is going to refer back surgery cases to a surgical specialist and it is sometimes hard to make the decision to drop everything and drive your dog or cat three or four hundred miles (if necessary) to a specialist. Some dogs will recover sufficiently without surgery to lead fairly normal lives but most dogs do not. This is an emergency situation and it is best to be prepared for it if you own a breed with a known tendency to develop spinal disc disease.

 

Exploratory Laparotomy

There is a strong tendency among pet owners and even among veterinarians, to avoid exploratory surgery when there is no clear diagnosis. The medical culture in our country supports advanced diagnostic techniques, such as MRI, CT scans and ultrasound examination over surgical exploration. There are obvious reasons for this. However, exploratory surgery is often less expensive than these less invasive alternatives and it is possible to fix problems that are found during surgery.

In at least one instance, that of a suspected intestinal obstruction, exploratory surgery should be at the top of the list for diagnostic procedures. If a problem is found, it can usually be treated and it is much better to find an intestinal obstruction early. This is so important that taking the risk of not finding a problem and having done surgery solely as a diagnostic test is worthwhile.

If money is tight and you are being asked to consider ultrasound examination, special X-ray techniques, MRI or CT scans, you might want to ask your vet if exploratory surgery isn't a better option, since it usually isn't a lot more expensive (and is often less expensive) than these procedures and it does provide the possibility of a cure as well as a diagnosis.

 

Common surgeries for which medical or other care is possible

Ear Hematoma Repair

It is not uncommon for dogs to develop ear hematomas. Cats also develop these but less frequently. A hematoma is a pocket of hemorrhage. When this occurs in the flap of the ear (the pinna), the ear swells dramatically. In some cases this seems to bother the pet a great deal and in other cases it doesn't bother the pet much at all. In cats most hematomas are related to ear mite infestation or insect bite allergy, based on our clinical experience. In dogs hematomas can occur for these reasons, plus allergic disease causing itchiness or ear infections, as a secondary problem when ears are infected and spontaneously with no apparent cause.

The major risk of hematoma formation is severe scarring of the ears as the hematoma resolves, leaving a "cauliflower" appearance to the ear. If the scar tissue in the ear flap contracts enough, it can cause blockage of the ear canal, making future infections of the ear canal more likely. So the major objectives in treating hematomas are prevention of scarring, treatment of any underlying cause and relief of pain.

Most veterinarians treat ear hematomas by repeated drainage of the blood or by surgical drainage of the ear and suturing completely through the ear to hold the outer skin and inner skin against the central ear cartilage to prevent the hematoma from forming again. This is probably the best treatment for ears that are painful and for very large hematomas, since it provides the quickest route to recovery. For hematomas occupying a small part of the pinna, or even for larger non-painful hematomas, an option that meets the objectives is to use corticosteroids such as prednisone to prevent scarring while the hematoma resolves on its own. Corticosteroids are very good at limiting scar formation, they are often beneficial in controlling underlying causes, especially allergies and immune mediated disease, and they help some in controlling pain, as well. We have had good luck using corticosteroids at normal anti-inflammatory doses in the treatment of ear hematomas. I think that the recurrence rate for hematomas is slightly higher when they are treated in this manner but treating the hematoma again is possible and using corticosteroids once does not rule out surgery if it seems necessary in the future.

 

Cruciate ligament surgery

Most veterinarians really believe that cruciate ligament surgery is beneficial when the cranial (anterior) cruciate ligament (CCL) is ruptured in a dog. However, there isn't much real evidence that this is actually the case, though. CCL injuries occur in the stifle joint, equivalent to the human knee, and usually cause sudden disuse of one rear leg without a lot of evidence of pain in the leg.

There is good evidence that dogs (and presumably cats) weighing less than 35 pounds will have almost no clinically apparent difference in healing times or subsequent use of the limb whether surgery is done, or not. There is at least one study, which followed two different and popular techniques for repairing cruciate ligament ruptures that concluded that neither technique was superior because 100% of dogs who had either surgery had laxity in the joint resembling the laxity at the time of diagnosis when examined five years later. The author's conclusion was that there was no advantage of one surgery over the other. My take on this was that there was no advantage to doing surgery at all!

For large dogs, a new surgical option for CCL rupture is a surgery referred to as tibial plateau leveling osteotomy. This surgery appears to be better than older surgeries based on initial findings but has not been studied over a long period of time and so it is difficult to be sure. I think that if I had a big dog I would consider this surgery at the present time but this opinion could change when long term studies of the surgery's success rate become available.

A case can be made for surgical exploration of the knee joint to make sure that there is no cartilage damage that occurred at the time of the CCL rupture. We try to make this judgment on a case by case basis, using the dog's level of discomfort and the progress towards use of the leg as a guide for which patients might benefit from surgery to assess and treat any cartilage damage. In this case, there isn't any really good reason not to try stabilization at the same time. It is possible that surgery might provide increased comfort for a year or more, even when it doesn't provide an effective long term cure.

 

Neutering

Injectable neutering using a chemical injected into the testicles has recently been approved by the FDA. I do not know when this "surgery by injection" procedure will become widely available but it is likely to be soon. For information on this, you can check out this web link: http://www.neutersol.com

 

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The opinions expressed in this newsletter are those of Michael Richards, DVM., author.

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