RE: Lilly’s surgery


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It’s Gulf Coast,
but who’s counting.


I’ll also be at GCVS
tomorrow to deposit Lilly. If Dr. Beale is available, I might try to get a few
words with him since we haven’t actually met. You know how surgeons are,
they do their cutting at the oh-my-god crack of dawn so the staff has the rest
of the day to eye recovering patients. Lilly is to come home Wednesday.


You might also want to talk
to a doctor, since they seem to be the decision-makers at GCVS. The staff just
follows policy, and yes, they can be rather snippy about it.


The guidelines for post-op
care for both procedures have been liberalized in recent years. Dikeman didn’t
advocate any special treatment after his traditional method, just a low-keyed recovery
with enough rest. Ha! That’s Lilly’s whole life-style! Dikeman was
initially surprised to hear that several TPLO surgeons are saying the same
thing. He pondered that for a moment, and then agreed it made sense. He’s
seen dogs walk after both procedures. The current protocol is to let the patient
(dog or human) determine its own limitations, because six weeks of inactivity does
horrible things to joints. As one source put it, it’s probably not a good
idea for the patient to go bounding up a stairway, but the worst likely outcome
would be a slow recovery because of the resulting sprains. The underlying
hardware would likely be fine.


Jack will ironically be
the least of impediments to Lilly’s recovery, because he’s already
spoiling her. He lets her ride the wheelchair lift to enter and leave the van! Ridiculous!
In truth, though, the biggest aid to Lilly’s recovery will be her
personality. You know how placid she is. The other dogs don’t get her to
do anything she doesn’t wish to. Only “Daddy” outranks her in
this pack.


TPLO reminds me of a
procedure sometimes done on humans with broken femurs. As we both know, the
traditional treatment is six weeks in open traction. But, in cases where the
patient can’t afford to spend six weeks flat on their back, the femur is surgically
set and secured with a plate. The plate acts as an internal cast, allowing the
patient to walk—gingerly—within days. Of course the main difference
is that TPLO tries to correct a flaw in the tibia. Whereas bi-peds have horizontal
tibial plateaus to support the femur, canine tibias have plateaus that slope
toward the back. The motion of the hind leg tends to force the femur down the
back of the tibia, doing all sorts of damage. The ACL and PCL are the only
ligaments that prevent it, and the former does tend to fail.


In TPLO, the plateau or
entire tibial crown (depends on the surgeon and case) is cleanly cut—not merely
broken—and rotated forward to be nearly horizontal. It’s then
secured in place with a surgical steel plate and screws. This basically renders
those ligaments unnecessary for stabilization. Here is one of many TPLO references. The traditional method is
the Lateral Fabellar Technique, where the femur and tibia are tied together
with monofilament nylon (yes, fishing line).
This is a viable technique for older dogs as they frankly may not live long
enough to suffer from the severe arthritis that tends to accompany it.


My personal reasoning for
selecting TPLO is based on the fact that Lilly’s left hind leg has less arthritis
than the right. Thus, it should benefit
more from TPLO. Since there’s a real possibility of the right ACL
failing, this will be an insurance policy for her mobility. Of course, I would
use TPLO on both legs in a perfect world, but in our sucky reality, the right would
likely get LFT.


From: Lourez Bullock []
Sent: Sunday, July 16, 2006 1:03
To: ‘Scott Royall’
Subject: Lilly’s surgery


Assume everything’s still on for sometime
Tuesday.  Dale and I plan to go by Gulf South tomorrow and make necessary
arrangements to pay the bill.  Hope they will allow a payout over 4 or 5
months…….we don’t like finance changes on credit cards.

I’ll email you Tuesday evening to see how she
did. When will she go home?  Is Jack on board about her recovery and
having the other dogs stay out of her way?


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