Biceps Tenosynovitis (Bugsy)

Jewlieee

So you may have said this already but has he been into the vet yet?

Jewlieee

It sounds like you aren't 100%sure what it is.

Jewlieee

Wouldn't you need the mri to make sure of what type of procedure is needed?

Jewlieee

You have insurance right? Will they require a vet diagnosis first?

The bottom line is that its a really hard thing to treat & diagnose. No one has given any downsides to the arthroscopic procedure that cuts the tendon. And I am completely done with the wait and see approach.

I went to bed tired and confused but watching him gimp around this morning I am ready for action again. I will try to speak to a particular vet from our practice today and then my friend tomorrow and then I'll make a decision and get on with it.

Honestly I am not going with the MRI, even with insurance it takes the whole procedure into a ridiculous amount of money. I know of someone in TX whose dog had this injury and it also took 6 months before a vet was sure and did the procedure. They didn't do an MRI, lets face it even 5 yrs ago it wouldn't have been the go to response.

As for dog mom of the year - I appreciate the support but we all know many go through much more and many go through much more with their human child which is much more emotionally taxing. This is really about running out of patience and recognizing that I have an aging dog who is still full of life and energy and deserves to be pain free to do the things he loves to do. 

 sounds like the mri wouldn't be the way to go and yeah, I couldn't afford that amount of money either especially if it isn't definitive. And waiting 6 months to do anything, yikes!

When are you going in next so you can get something scheduled?

 At this point I am thinking that I'll have a cortisone shot in the biceps tendon, if that clears the pain we know that is the affected tendon (I may have said I am 98% sure it is anyway). As soon as I could confirm its that tendon I will schedule to have it cut via arthroscopy. I hope to have it sorted by the end of next week for sure.

What i don't know is if I would need to wait after the cortisone before having the procedure

 LOL so was I ............I put some links in the first post that explain but they cut the tendon from its attachment to the shoulder blade but over time it will reattach to the humerus bone. One article mentions that it can be anchored there at the time of surgery but they seem to only talk about that with agility dogs and working dogs.

A different muscle and movement will take over for the action that the tendon guides and from reading that is the recovery part - so 6-8 wks of leash activity only then it might take 4-6 months for full range of motion

I am back to head spinning mode. I don't really even want to wait until tomorrow to decide but I should try to be that patient LOL

 Just spoke to my vet - I am bringing Bugsy in for the cortisone shot and xrays under sedation on Thursday

Bad news is he said that although they always attempt to insert the cortisone into the specific tendon some may actually impact the other 'possible' tendon SO it isn't a definite diagnosis 

Ugh Karen - nothing is ever easy, is it? I'm thinking about you and hoping for confidence and clarity on whatever path you choose.

kpwlee

Bad news is he said that although they always attempt to insert the cortisone into the specific tendon some may actually impact the other 'possible' tendon SO it isn't a definite diagnosis 

Geez, could it get any more difficult?  I'm so bummed for you that this won't be 100% definitive.  I guess it's as good as it gets though and if he improves, surely the odds are greatly in favor of it being the tendon most commonly torn.

 Thanks ladies - the only thing everyone has agreed on is that shoulders are nearly impossible to diagnose. At least in 48 hrs B should be pain free. It should buy me some time to keep looking into the surgical options. My vet is fairly old school which is why I wanted to speak to him - I knew he'd give it to me straight and that he would completely understand about the financial aspects. Also he is a long time breeder/owner of labs so he has a good idea of nutty dogs

Boy, I can't imagine how stressful and exhausting this is, Karen.  Just reading all the different aspects of the situation as you've been examining things thus far has me stressed out!  I hate having to make decisions about stuff like that -- I prefer black and white data when I have to make a choice (I know, I know --- that's not how life works)!

Shoulders in dogs must be like shoulders in people.  When I was scheduled for a shoulder ultrasound, I had to go to a certain place in town because there are only a couple local people who can ultrasound shoulders.  When I had my appointment, I asked the guy why that was, and he said it's partly because the anatomy of the shoulder is more complicated than other joints, making things difficult to assess, the process of doing the ultrasound is very specific, etc. 

I also remember when my MIL fell last year and did some damage to her ankle.  One doctor told her things like torn tendons and sprains are worse to deal with, and sometimes a clean break is easier to treat.

None of that has anything to do with Bugsy ----- I guess I'm just trying to say you have my sincere sympathy.  I sure hope you can get the info you need after the cortisone shot (and from talking to your friend, etc.) to feel like you can make the best decision.  The good thing is it sounds like Bugsy is in good spirits (as long as he keeps his leg off the ground!).  It would be worse if he was curled up in pain, wimpering, not at all like himself. 

Sending good vibes to all of you!   

 ugh just typed a response and lost it....

Julie the cortisone will likely only help for a month or less, so surgery is still my intent. It will buy me some time to research but I hope to have it done in the next two weeks IF we can confirm its the tendon.

The hope is that the xray will show fluid and/or calcifications near the tendon insertion point. If it does than we can surely say its that tendon. In some ways the recent acute injury should help with diagnosis.

I explained to my vet I was 100% interested in a long term fix not a short term fix. Bugsy deserves to not have to deal with this.

Meanwhile the stubborn beast decided to coax the neighbor's cocker spaniel to bolt from her and run like an idiot with him all over the yard. I knew that by the time we captured the cocker and Bugsy agreed to come in he'd be toast. And he was. Completely 3 legged again but smiling.

He really has an amazing outlook on things LOL

Bugsy smiling with 3 or 4 good legs makes me smile Shoulders do sound so difficult to diagnose! But, at least the cortisone (or however you spell that word) buys you some time and gives Bugsy some pain-free weeks. 'Cause we know he's not gonna slow down!!

If you want a ref for Tufts Vet School (2nd or 3rd opinion) just let me know. I have a contact who was there. (He's a vet whose specialty is work with military dogs--he knows active.)

Sorry -- it's been an insane day so I didn't get to look at all this til now.

In the "for what its worth" dept, Karen -- I think you are absolutely positively going in the right direction with the steroid shot to see if it "calms down" the tendon **as the means of diagnosis**. 

In the medical realm, in reality there is almost never a "for sure" diagnosis -- it's all too easy for something to masquerade as something else -- I see it all the time in IMHA and the other stuff I've dealt with. 

SOOO?? So you do the thing that is most apt to give you the *best* information you can get, BUT AT THE SAME TIME, you do what is easiest on the dog and you.  For an MRI Bugsy would have to be sedated and likely kept in a very uncomfortable position (which will further make him hurt).  A steroid shot? That's a win win -- because the very LEAST it will do is make him feel better, and it also gives you a danged good idea what you're up against. 

Sometimes you go with the best information you have plus your own "gut" reaction.  Because bottom line -- you know this dog better than anyone and that gives everyone valuable information.

Usually with dex (and I'd assume that's what they'll use?) you feel a BUNCH better right away.  So you oughta know by the end of the day even how much 'better' ergo ... is this right! 

So is the surgery totally off for Thursday?  I'm not clear after what I read above.

And back at the ranch?  Remember Karen -- there is NOTHING on this planet like the "good thots and prayers" that come out of this group of people.