TPLO

Yes. Both orthopedic specialists recommended by their regular vet.  Or the vet who's name is attached to the clinic we use.

And 2 actually 4 differing opinions on the x rays and Maven.

No one has been able to get a huge amount of drawer on the left. 2 have said that they could get a pop and nothing else. I have heard a pop and felt crepitus. Which the last vet stated was from the patella.

First vet was a twit ( perhaps I was too quick to be frustrated). She couldn't read the xrays and was unsure of which leg. Said no effusion and unsure of anatomy and where there might have been sesamoids.. Radiologist sees xray, 10 days later notified that she has a fracture aka chip on the right patella and a possible cruciate on the left..  The superior to vet #1  reviews xrays and said definite effusion, and a chip distal to the patella on the right and a liable to be chip on the distal end of the patella on the left. Has bad patella conformation. (she is built straight up and down behind) . Recommendations from #2 to specialists

First specialist says both stifle 's have a fair bit of laxity(sp?) and a cruciate is probable on the left. Not alot of drawer. though some on both. Growth plates are wide open. TPLO is the only thing to consider. Blood drawn. Walk out with a $300 bill and a schedule of fees for surgery.

Specialist #2.

Growth plates close to closed.  Chip is non existent. Effusion. No real drawer. Similar on both. Though has laxity on the patella and audibly pops it back in.... back to vet #1. She said she didn't get a drawer, but had a pop that she couldn't get twice...  He says he's not convinced that it is cruciate, and leans toward patella luxation which is a $2000 surgery, though if they get in and it is the cruciate, then they head toward the cruciate for $4000 or take care of both for $6000.

Should I be extraordinarily stupid and take this to an equine vet for his take or an equine surgeon? So different, but I trust the guys I deal with. Is my equine knowledge getting in my way or is it a help?

At this point I have no idea.  I literally swimming up stream. 

I don't know who is right or who is wrong or who has my dog's best interest at heart or not? I hate to be cynical, but this is the most amazing bunch of BS I've ever run into. And it is either going to cost me a little or a heaping lot. I just don't want to take it up the hoop because I am a dumb ass.

Well, I'm certainly not an expert on this stuff by any means.  But, both of Willow's patella's luxate and from what I was told there are varying degrees--which sorry if you are already familiar with this.  Willow is able to stretch her leg a certain way and self correct it.  So, if your dog is able to do that this might not be something that needs surgery at this point.  It could get to that point but you might not be there yet.  Besides the self correcting stage I mentioned there is at least one more stage before it's something that needs surgery now. 

The reason I asked if you were seeing an orthopedic is because I didn't get any straight answers myself until I took her to one.  She's got arthritis in both shoulders--worse on the side that she doesn't favor.  But, her regular vets had me thinking it was her elbow and it wasn't that at all. 

Frankly, I wouldn't be comfortable with any of the vets you've described operating on my dog.  They are too conflicted and they seem to have their issues--not someone I'd be comfortable with doing surgery.  If it was me, I'd get yet another opinion.  Maybe the horse people you know and one other ortho specialist for dogs.  And, see where you are then. 

Good luck,  ortho issues can be so tricky.

Too bad you aren't close to RI, the guy Willow saw was really great. 

 Ok..ortho issues are EXTREMELY DIFFICULT. Conflict is inevitable.  I feel for your situation, but trust me....some of the best ortho surg guys at my school still disagree a lot and they have been doing it for years on end. Don't blame them, or think they're stupid or BSing. It is not as simply as yes, this is normal or no, its not. Its a horribly gray area of study and very difficult to interpet (which is why it pays so well...if only I could get into it)

Should I be extraordinarily stupid and take this to an equine vet for his take or an equine surgeon?

 Dog legs are VERY, VERY different from equine legs. That's be like sending a soccer player to tennis camp. Sure, it's a sport and they can probably do it ok....but he's an equine vet for a reason - he knows horses a lot better than dogs. A small animal person knows cats better than cows. Etc.   Dogs are a lot different than horses structurally and orthopedically.

TPLO.....very risky, very invasive, not proven to be better than traditional repair or new minimally invasive methods to correct the problem.

Read the multiple studies in JAVMA. That's incorrect. TPLO is far superior in terms of overall success and prevention of recurrence, and is not "risky" at ALL when done by an experienced surgeon. The old suture tie method has a much higher rate of recurrence.

I can see them questioning what the best way to proceed is.  

But, specialists who are conflicted about what the x-rays are actually showing concern me.  They certainly should be able to look at an x-ray and see what is there or isn't there. 

And, I'd probably get an MRI if possible before I'd have them basically explore to see if there was any type of tear.  Bascially, the doctors I talked to weren't ready to jump to operate on a luxating patella unless it was extremely serious.

 They certainly should be able to look at an x-ray and see what is there or isn't there. 

 X rays are extremely difficult to interpret in ortho cases also - even for specialists. A fracture? Sure. Swollen organs or tumors? Sure. But telling if that patella is 2 cm over from where it should be, or if it is just a tiny angle of the film, fluid obscuring tiny structures, whether the millimeter of lucency is just a film artifact or a lesion....we spent a long time on rads in Musc/Skel Med, and seriously - the mild luxations and things like that are far the most difficult type of thing to Dx by rads - practically impossible to get a solid Dx , you need other things. You really can't just "look at an X ray and see what's there"

I'm not trying to be huffy about it,and these vets might be incompetant (honestly...if they are board certified surgeons it is unlikely - are they certified in anything or do they just "consider themselves" ortho specialists?) just trying to say that rads aren't always diagnostic and are almost always at the interpretation of the reader.

I can only imagine how frustrated you are.  I would feel equally upset but if I was in your position I would get one other ortho specialist consult.

My eleven year old Lab had no post surgical complications.  She was not EASY to keep inactive for the long recovery as she was a very active, high energy dog.  I kept her confined during the day in an ex pen and she wore a short lead all the time so I could make sure she did no jumping or running.  Yes, it was a PITA but well worth it to see her finally recover and have a normal life again.  I hope you get some answers soon and please keep us posted.

 Yeah, I think at third point a 3rd opinion to see where the "split" is would be indicated. I really wish you luck as well - these things can be soooo multifactorial and it's hard toget your head around it, and the diagnostic incostistency can be very frustrating. Fingers and paws crossed! Have you considered seeing a specialist at a state vet school, if you live near one? They are generally MUCH cheaper.

whtsthfrequency

the mild luxations and things like that are far the most difficult type of thing to Dx by rads - practically impossible to get a solid Dx , you need other things.

OK, well as a pet owner where I'd be with this if this was my dog is that if it's so "mild" that they are having trouble interpreting it then it can't be bad enough to warrant a surgery??

I am so exhausted by this that I am waving a white flag of surrender.  And still I don't know what the right thing is. Crack her open and leave her to whatever they find?  I can't do it. I want a diagnosis. Maybe it is asking far too much.

  if it's so "mild" that they are having trouble interpreting it then it can't be bad enough to warrant a surgery

 The problem is, mild things get worse if not corrected.

 Foxysox, I *really* hope they can get some more info - it relaly must be terrible kto be stuck in limbo :(

I think I am actually physically ill over this. 

I'd be sick too!  Sick of all the run around and wondering what to do!  Sorry for you and hoping you get some answers soon. Answers that make sense, that is!

 So sorry this is so difficult for you. **hugs** It is so hard you want an educated opinion and well they just give you more questions. Have either of these "specialists" not been associated with your regular clinic? I don't know if an "outside" third opinion might help. Sorry I know this is difficult.

I agree x-rays can be hard to read an interpret. When we thought Teddi had elbow dysplasia, the x-rays showed nothing. Both my vet and I agreed it was worth having them read by a radiology expert for their opinion, they too saw nothing as did the ortho surgeon. Money wasted? Not really. Of course I was just paying for xray reading more or less, but I did have another trip to the ortho surgeon. 

I know nothing about luxating patellas, so I can offer any words, but like I stated earlier my golden had 2 TPLO's in less than 2 years time. She is doing magnificently. I have no regrets. She came through the surgery with flying colors too. You should see her run and play with my younger dogs. Post op was not an issue for her she can be kept easily complacent. 

If you go for a third opinion, arm yourself with lots of questions. It could help you. 

Thanks

Yes they were both recommended by our regular vet.

Something has to be done. No doubt about it.  She won't be kept quiet easily.  She's a high high energy kind of girl. I guess a 3rd opinion is needed. Why does this have to be such a mess.