Operate or not? Huge dilema with our little rescue

[TheFlyingFauxPas]

Many may remember my previous thread about ddog. He is a rescue, roughly 2 years old. Probably Yorkshire Terrier / Jack Russell cross. Weighs about 5kg. We got him in Jan. This year. Going to save this now but there's more. Bare with...

He is wonderful. When we 1st got him when in one of a few vets visits for vaccs etc one yet thought he had ALD (angular limb disorder) recommended xrays to diagnose and suggested surgery would probably be necessary. Lots of discussion followed with rescue etc as at that time we hadn't adopted him. Now we have. She thought vets were being overzealous and lots of dogs have Queen Anne legs. Vet said secondary osteoarthritis in front wrists virtually inevitable. Surgery now should prevent. If we don't operate and it occurs it will be too late.

This has dragged on and on and I felt awful. Rescue took him to their vets originally. They didn't pick anything up.

As I now can't insure him for this I got signed up with a local PDSA vet (as we're talking approx £5000 for both) she said he's not in pain he's never lame and surgery hugely invasive and not guaranteed to work.

I went back to vet who originally spotted it. Told him all this. He's still of opinion surgery's best. They did the xrays for me. Definitely diagnosis. Problem would be wrists. Not elbows. Recommend surgery asap - weeks def not months to prevent OA.

Spoke to rescue. She got us an appointment at the vet. hospital they used when he was rescued, castrated etc. I emailed xrays and vets report to them. His first question was about his pain. I said he never appears in pain or limps. He said we should not operates. 3 reasons. He's not a heavy dog, he's stopped growing and he doesn't appear to be in pain. Other vet Sai he is as when he poked his legs he growled. Other vet said he'd probably do that anyway. Kind of saying surgery would be invasive, cruel, unnecessary and painful and he wouldn't do it to his dog or recommend surgery. I need to weigh up which is worse. Operate now or pain later if don't operate. He's very much of opinion surgery now is worse.

Are you still with me? 😊 Two completely opposing expert opinions and I really don't know what to do. (there would be money available to pay)

Of course you'll need a pic 😉

If you don't operate now, his wrists get arthritic changes and he's in pain...is there anything then that could be done or is it just pain management?

Third vet? Difficult situation for you. He is totally gorgeous btw.

Sounds like one for Noel Fitzpatrick.
You need an expert opinion which you can trust.

"Sounds like one for Noel Fitzpatrick.
You need an expert opinion which you can trust."

That's a hell of a lot of money for a third opinion...and I know people really admire him, but he does operations that I think are ethically on dodgy ground TBH.

Are either of the vets offering differing opinions orthopaedic specialists? If not then I'd ask for a referral to one, get their opinion and then go from there.

Whether surgery is necessary or not depends on how severe the deformity is and if conservative management alone (which is mostly exercise restrictions and religiously keeping the dog at a healthy weight) is appropriate.

A shorter life without the hideousness of orthopedic surgery. Definitely.

If he has surgery he will not understand that he will get better- he will just be living in the moment of a horrible experience.

3 opinions.
1:The one who says operate is the one who picked it up, x rayed and spoke to the Orth surgeon at his place. Say outcome will be poor if wait and see and if it develops of which the chance is very high. They say it's severe.
2:At the pdsa vets said don't but I don't have a lot of faith in them and didn't seem to have heard of the ALD.
3:Vet hospital said don't do it. Spoke at great length. They did give me a couple of Orth specialists to contact to discuss merits of surgery.

It's so damn hard. Yes Bert that's what the non-op vets are saying. Very hard when 2 experts have very diff opinions. I need a crystal ball 😞

I love him so much. I really want the best for him. Very hard when don't know what the best is 😞

My original thread if you want to see it

You need to decide, based on qualifications, who is the expert. That's who's opinion I would trust. Just because the first vet spoke to their "ortho surgeon" doesn't mean that he is an orthopaedic specialist. He/she may have done a certificate, but again this doesn't denote specialism. One of the vets I work with does orthopaedic surgery and has done extra training but he's certainly not a specialist.

Angular limb deformity and carpal surgery is not common and very specialist work. I'm a general practice vet and wouldn't even pretend to know the ins and outs the surgery involved, though wouldn't class myself a rubbish vet because of it. I would get the opinion of the orthopaedic vet I refer such cases to and trust them with their recommendation.

It is a tough one and both decisions come with risks :( wouldn't dare give an opinion without speaking to a specialist. I agree you are between a rock and a hard place with conflicting opinions.

Is the animal hospital a referral hospital? Have they actually examined your dog?

Oh 8days. It's so hard 😞 No vet hospital not a referral hospital. They've given me details of 2 if I want to approach them for their opinion. Short of me studying and qualifying as an Orth spec myself I do not know how to decide for the best. Only the vet who recommends surgery has had his orth surgeon who would do it look at the case. They talk as if I should not consider inaction, but the other practices talk as if I'd be wrong to consider surgery. Do you have a dog? What would you do? Though you haven't seen or referred him your expertise far outweighs mine 😞

Yes I have two little Shetland Sheepdogs. One of them became acutely lame at 9 months old - I really wasn't sure what the cause was but emailed X-rays and spoke to the specialist ortho vet who reckoned it was displacement of the superficial digital flexor tendon - a condition only ever seen in Shelties and very occasionally in greyhounds! Hardly any Shelties about so I had never even heard of it and neither had my colleagues or friends (bad mum feeling!!) or her (in my opinion very good) breeder.

Anyway I visited the ortho vet and he said if it was his wife's wee pup he wouldn't operate and see what happens. About 4-6 weeks later she was back to normal and has been fine since! Now, that injury is totally different to ALD obviously, but I guess what I'm saying is it pays to listen to the specialist. It's easy for me because I have decided who I trust with my clients pets and who has the best surgical outcomes, I can't imagine how difficult it is when you don't have this info :(

So worst outcomes if you don't operate now: little one will develop arthritis at a young age, will need lifelong medication and possibly put to sleep at a young age

Worst outcome if you operate: surgery is unsuccessful and arthritis and pain sets in a lot quicker and you'll have less time with him.

Also, even if surgery was as successful as can be, he will still get arthritis in those joints, albeit at a later date than if you don't operate.

Ahh I don't know. Tbh if someone told me it would be cruel, involve suffering etc I'd just let nature take its course, provide pain relief if/when the time comes and let him enjoy his happy life now.

He's a very lucky chap to have you as his owner!

Thank you 8days 😊 xx

You wouldn't know. He's so lovely

My mum has a JRTx Border terrier with the same problem , it's very noticeable , we've had him since he was 8 weeks old , he's now 14 ( 15 in December) ,he's got arthritis in all his legs and has been on daily Rimadyl for the last few years ,since he had a cruciate problem which we chose to treat with bed rest ( tried swimming and he hated it) . Personally I think he's had a good innings , he has to have steps to get on the sofa but aside from that he manages ok . Conclusion - I wouldn't operate .

I love it that he still gets on the sofa Flora 😊 I do worry about recovery if he were operated on as he loves a good caper about and he leaps about however much I try to stop him.

What you need to remember with the PDSA is that they are not funded to do anything but necessary work so their vets are not going to suggest expensive choices .

I have read the thread what I would suggest as a vet is give us your rough location eg Birmingham and myself or other vets who have read can suggest RCVS and ECVS specialists close to you. These are vets (like Noel Fitzpatrick) who have been recognised by taking exams and by a team of their peers as being the top people in their field. He is not the only person there are people all over the country who do this without the flash and splash who we can suggest.

I wasn't suggesting not seeing a specialist btw, I assumed (mistake obviously, shouldn't assume stuff) that that's who'd been seen at the vet hospital.

What a cutie he is!

Agree with PP: you need to decide who has most expertise of the people you've seen, and if you can afford it get an opinion from an ortho vet.

if he;'s not in pain and not having any side effects then i personally would consider not having surgery yet. Obviously if he was in pain or it as impacting o is day to day life I would say go fr teh surgery./

I'm another vet who agrees with Lonecat above - if you give a rough idea of location, we can advise on specialists who could give you a more informed opinion. As a general rule, the smaller the dog, the more they can get away with dodgy joints - this is simple laws of physics, if less weight goes through the joint it puts less strain on it. But it would certainly be worth getting input from a specialist - as LC says, there are many good ones out there who the public don't know about.

You also need to ask about timescales, don't you? Because if there is a good chance he will have a happy quality of life for a reasonable time without surgery I would always go for that. But I don't believe in "heroic" surgery for animals, and I think that Telly man should be struck off. So I'm probably not the right person to ask.

For what it's worth, my friend has a JRT who has badly deformed front feet and walks on her wrists. She gets on absolutely fine, but will at some stage get arthritis in her other leg joints. She's 4 now, and the vet says she's probably got another 2/3 years before hard decisions have to be made.