Suitability for amputation

RE: Suitability for amputation

Anthony Dennison — Thu, 21 Jan 2016 17:56:54 GMT

[quote user="David Mills"]

[quote user="Anthony Dennison"]GMAH won't do the op.[/quote]

Surprising.

[quote user="Anthony Dennison"]just got to try and get the op done now[/quote]

If you're orthopaedically minded or inquisitive, and you haven't done one before (or even if you had), then could you talk to your bosses and do it for a reduced price scrubbed in with another vet? Would be more valuable than much CPD around. Our cost for something like this (tibial crest transposition +/- sulcoplasty) would be around £300-325 to give you a ballpark figure. It's not a technically demanding surgery when you done one or two.

Cannot stress enough the importance of biomechanically altering the leg if you want a good outcome.

[/quote]

Thanks David - this is my line of attack for now. Have to say, I'm a 2012 grad and haven't done a single ortho op. Just not as interested in it as I am my medicine, but it's a useful skill to know so probably should get on with the basics, which includes this op.

It's an RSPCA dog, so it should be a win-win with regards to using it as a teaching opportunity. Will just have to see if my boss agrees...

RE: Suitability for amputation

David Mills — Thu, 21 Jan 2016 17:12:56 GMT

[quote user="Anthony Dennison"]GMAH won't do the op.[/quote]

Surprising.

[quote user="Anthony Dennison"]just got to try and get the op done now[/quote]

Cannot stress enough the importance of biomechanically altering the leg if you want a good outcome.

RE: Suitability for amputation

Hannah Wynne Richards — Thu, 21 Jan 2016 16:14:25 GMT

Good luck!

Wynne

RE: Suitability for amputation

Anthony Dennison — Thu, 21 Jan 2016 15:31:14 GMT

So, GMAH won't do the op. If they had picked up on the issue when he was there, they would have euthanased him there and then.

Got a potential foster home, just got to try and get the op done now!

RE: Suitability for amputation

Hannah Wynne Richards — Thu, 21 Jan 2016 15:28:32 GMT

Well said Ruths

Wynne

RE: Suitability for amputation

ruths — Thu, 21 Jan 2016 15:20:36 GMT

[quote user="Anthony Dennison"]

[quote user="ruths"]

It's a bloody pain, isn't it?

what breed of dog is it? another long legged sbt?

[/quote]

yeah. They're calling it an 'American Bull Terrier cross'. Beautiful dog though, and a right sap. Compared to some of the other dogs I've euthanased because of medical issues, he's perfect.

Thing is, they're not averse to spending a bit of money. Recently had a dog returned to the shelter because he had bitten the owner - turns out it was provoked. They paid for a behaviourist to come out and assess him, and he's been cleared.

[/quote]

<sigh>

reminds me of the 'story' about a little girl walkng on a beachthat has a bazillion starfish on it. You know how they get washed up and stranded.

She is picking up the ones she can and thorwing them back into the sea. when somebody says to her that it's a waste of time and it won't make any difference, she replies, 'well it will make ALL the difference to the ones I throw back in'

I'm sorry, i don't know how to attach this to a winsome photo like the ones on Facebook -))

Maybe you could nick the dog?

Or suggest that the shelter send him onto another rescue

RE: Suitability for amputation

Anthony Dennison — Thu, 21 Jan 2016 12:05:01 GMT

[quote user="ruths"]

It's a bloody pain, isn't it?

what breed of dog is it? another long legged sbt?

[/quote]

yeah. They're calling it an 'American Bull Terrier cross'. Beautiful dog though, and a right sap. Compared to some of the other dogs I've euthanased because of medical issues, he's perfect.

RE: Suitability for amputation

Bob Russell — Thu, 21 Jan 2016 11:15:08 GMT

[quote user="Hannah Wynne Richards"]

That is unfortunately true, but call it what it is - a contract killing

Wynne

[/quote]

Actually call it focusing limited resources as efficiently as possible. The cost of this procedure would cover advertising costs for many dogs looking for homes.

Not every stray or homeless pet can be saved!

I would not be going for amputation because these are almost always bilateral and you can pretty much guarantee it will go lame on the other leg!

RE: Suitability for amputation

Robin Grimmer — Thu, 21 Jan 2016 10:24:18 GMT

I have to say I agree with Wynn re surgical technique. I have always done a wedge sulcoplasty and lateral capsular overlap in the majority of my MPL patients and I can't recall one that has failed.

RE: Suitability for amputation

ruths — Thu, 21 Jan 2016 10:09:18 GMT

It's a bloody pain, isn't it?

what breed of dog is it? another long legged sbt?

I worked in east London years ago- I'd moved from west London.

at that time, I never saw a patella luxation in a SBT in West London.

In east londoN, they were rife....

Sometimes there can be a fair bit of fixed thinking about things. I totally understand the policies and rules and have killed a fair few animals myself whilst internally being very upset. I've also rehomed lots of animals into my own home -))

It would be lovely publicity for the branch- single out this dog and get lots of support and air time etc....and then make an individual decision about the next dog.

keeping it in the shelter for a long time will likely be a self fulfilling prophecy and it will end up euthanasee due to iatrogenic behaviour problems -((

good luck with your discussions....

RE: Suitability for amputation

Anthony Dennison — Thu, 21 Jan 2016 09:34:43 GMT

Thanks everyone for the feed back. Obviously I don't want to do either of the options I've suggested - just wanted more people's opinions to take back to them!

[quote user="Robin Grimmer"]Have you tried some NSAID to see if it settles with conservative treatment?[/quote]

Yes, currently on NSAIDs. However, they had a staffie last year with a similar grade luxation which didn't get any better. This one had been in the shelter for almost a year and wasn't the easiest to rehome due to some stubborn behaviour, so unfortunately he was euthanased.

[quote user="David Mills"]They should have fosterers in place for this kind of thing.[/quote]

Yes, they should, but currently they're dragging their heels about having someone. Mainly because of a dog that had a lateral suture a couple of years ago took much longer than 6-8 weeks to get right (though I suspect they weren't following post-op instructions).

[quote user="ruths"]

Would they be able to do a specific fundraiser for this dog if referral was indicated?

Or advertise him as a bit wobbly and needing some attention immediately after adoption?

[/quote]

They've mentioned specific fundraisers, but then the manager asked that if it was done with this dog, 'where would it stop' - thinking all animals would need fundraising. Bit annoying.

[quote user="Clive Ansell"]There are endless stray and unwanted dogs, we cannot rehome or cure all of them all of the time, and rescue centres are bursting at the seams - euthanasia is an acceptable therapeutic option in some cases.[/quote]

[quote user="Hannah Wynne Richards"]

That is unfortunately true, but call it what it is - a contract killing

Wynne

[/quote]

I prefer the word 'mercy' over 'contract'. A contract killing suggests that I don't mind doing it. I don't. I hate it. However, all of the animals I have put down from the shelter have had some sort of medical or behavioural issue that would make them very difficult to rehome, if at all. Some of them would be ok if they went to the right home, with an experienced owner that was willing to put in the work. IME those sorts of homes are like hen's teeth.

[quote user="David Mills"]Could you not get GMAH to do it? I'm sure they would if you contact them, we do branch work like this fairly frequently.[/quote]

I mentioned that. The dog came through GMAH with this problem, so it wasn't picked up, which might sway things a little. I'll probably get in touch with Dave myself, as I don't think the shelter will do it.[quote user="Iain Richards"]Euthanasia is a perfectly acceptable option on all angles. For the dog, death is a nil situation. There is even a welfare argument that the nil situation is better than long term discomfort if left or further discomfort if the other side fails with the extra load post amputate. As it's a rescue centre the money can go to helping many more animals[/quote]

Thanks Iain. This is how I think about it. Sucks, but has to be done sometimes.

RE: Suitability for amputation

Francisco Gomez — Wed, 20 Jan 2016 21:04:22 GMT

[quote user="David Mills"]

[quote user="Francisco Gomez"]Very unfair comparison IMO, you might be extremely busy where you are but the ethical dilemmas remain the same despite of the number... [/quote]

Not at all. It's easy to posture in black and white when you cocooned in cotton wool

[/quote]

I stand by point, you might process it quicker, but you would still go through the same thinking process to decide if you should euthanase or not an animal.

RE: Suitability for amputation

Iain Richards — Wed, 20 Jan 2016 20:55:18 GMT

Euthanasia is a perfectly acceptable option on all angles. For the dog, death is a nil situation. There is even a welfare argument that the nil situation is better than long term discomfort if left or further discomfort if the other side fails with the extra load post amputate. As it's a rescue centre the money can go to helping many more animals

RE: Suitability for amputation

David Mills — Wed, 20 Jan 2016 20:54:02 GMT

[quote user="Francisco Gomez"]Very unfair comparison IMO, you might be extremely busy where you are but the ethical dilemmas remain the same despite of the number... [/quote]

Not at all. It's easy to posture in black and white when you cocooned in cotton wool (or Welsh rain). Much like people from Islington/Guardian readers talking about how to solve poverty or telling people how to think about immigrant integration in northern mill towns.

[quote user="Francisco Gomez"]We can always tie with the privatisation of public healthcare and the likelihood of euthanasia becoming legal in the UK. Once the problem becomes too hard to manage, we could get the private insurer to push for it: Patient killed, problem solved.[/quote]

Oh, euthanasia will arrive in our lifetimes. And it won't be because of the ethics, but it will be because we physically won't be able to afford to care for old people. It'll be the most compassionate advancement of our generation, albeit growing from economic pressures.

Anyway, if you want to spar on stuff like this let's start a tangent

[quote user="Francisco Gomez"]if even possible, price down the op to the amputation [/quote]

Could you not get GMAH to do it? I'm sure they would if you contact them, we do branch work like this fairly frequently. They'll do quite a few of these down there with the great unwashed of Manchester's handbag dogs.

RE: Suitability for amputation

Francisco Gomez — Wed, 20 Jan 2016 20:46:04 GMT

[quote user="David Mills"]

Think you may need to step out from the valleys once in a while. Why not come to London and I'l show you how many healthy animals we kill?

[/quote]

Very unfair comparison IMO, you might be extremely busy where you are but the ethical dilemmas remain the same despite of the number... Or is it like in the crime dramas? Once the killer has done the first one, the rest will be easier...

We can always tie with the privatisation of public healthcare and the likelihood of euthanasia becoming legal in the UK. Once the problem becomes too hard to manage, we could get the private insurer to push for it: Patient killed, problem solved.

[quote user="Anthony Dennison"]

Would amputation be a feasible option?

[/quote]

Sorry for the dig at David , Anthony. I actually agree with him on the ends, but not in the thinking process.

+1 amputation being an overkill as well as possibly asking for trouble. Tibial crest transposition is not that technically demanding (it is one of the very few orthopaedic ops that I feel comfortable practising).

Would consider, if even possible, price down the op to the amputation (since it is a charity case), but making sure they understand the potential complications and the need for recovery time.

RE: Suitability for amputation

David Mills — Wed, 20 Jan 2016 20:28:34 GMT

[quote user="Hannah Wynne Richards"]

I'm the 1st to admit it's a 2nd best option, but when the other choices are amputation or death, well, it's got to be better than either of those.

Wynne

[/quote]

Problem is it's a bad option - I certainly wouldn't class it as 2nd best - and wouldn't even consider it for a grade 3 luxation. The likely benefits are minimal and the costs are high - chopping into bone isn't benign, there is potential for catastrophe, the dog is laid up for 6-8 weeks and the patella (even if you can get it into the new groove) will re-luxate inevitably. If you think different for grade 3s, then you haven't been doing grade 3s.

Euthanasia isn't a welfare problem. Think you may need to step out from the valleys once in a while. Why not come to London and I'l show you how many healthy animals we kill?

RE: Suitability for amputation

Hannah Wynne Richards — Wed, 20 Jan 2016 18:31:58 GMT

That is unfortunately true, but call it what it is - a contract killing

Wynne

RE: Suitability for amputation

Clive Ansell — Wed, 20 Jan 2016 17:50:28 GMT

[quote user="Hannah Wynne Richards"]Please don't say euthanasia - that word should be reserved for the truly incurable.[/quote]

Why ever not?

There are endless stray and unwanted dogs, we cannot rehome or cure all of them all of the time, and rescue centres are bursting at the seams - euthanasia is an acceptable therapeutic option in some cases.

RE: Suitability for amputation

ruths — Wed, 20 Jan 2016 17:45:44 GMT

[quote user="David Mills"]

[quote user="Hannah Wynne Richards"]Well I'd charge less for an old fashioned luxating patella op - deepen groove and tighten ligament - than for an amputation[/quote]

If it's grade 3 this won't do much good IME. It will need a tibial crest transposition. If you want to reduce surgery time, then just doing a transposition has been forwarded in recent years at it is a biomechanical issue that causes MPL, deepening the groove does not solve this, just pulls the ligament round a corner.

The dog in question needs either surgery or euthanasia (assuming conservative tx fails which for a g3 it normally will). They should have fosterers in place for this kind of thing. Amputation is asking for trouble, quickly, on the other leg. If it was me I would set this out very clearly to the rehoming centre, no negotiation.

[/quote]

Agree with David here completely.

Would they be able to do a specific fundraiser for this dog if referral was indicated?

Or advertise him as a bit wobbly and needing some attention immediately after adoption?

or could they chat with another charity who are more inclined/ableto do the surgery he needs?

RE: Suitability for amputation

Hannah Wynne Richards — Wed, 20 Jan 2016 15:40:10 GMT

I'm the 1st to admit it's a 2nd best option, but when the other choices are amputation or death, well, it's got to be better than either of those.

Wynne

RE: Suitability for amputation

David Mills — Wed, 20 Jan 2016 15:26:36 GMT

[quote user="Hannah Wynne Richards"]Well I'd charge less for an old fashioned luxating patella op - deepen groove and tighten ligament - than for an amputation[/quote]

RE: Suitability for amputation

Hannah Wynne Richards — Wed, 20 Jan 2016 14:12:05 GMT

Well I'd charge less for an old fashioned luxating patella op - deepen groove and tighten ligament - than for an amputation. It takes a lot less time. Recovery time would be about the same. Of course, if you want to do one of the modern knee remodelling jobs (which I would refer, but I realise this isn't an option for a charity) then both the op will be much more expensive, and the recovery will be longer. I'm not claiming the old fashioned op is as good as one of the more modern ones, but ot must be better than either amputation or death. Please don't say euthanasia - that word should be reserved for the truly incurable.

Wynne

RE: Suitability for amputation

shanley barber — Wed, 20 Jan 2016 14:10:19 GMT

I would second the above - rest & NSAIDs are indicated first, even before surgical repair of the MPL, IMO.

RE: Suitability for amputation

Robin Grimmer — Wed, 20 Jan 2016 13:42:07 GMT

[quote user="Anthony Dennison"]

Would amputation be a feasible option?

[/quote]

Seems a bit extreme. Have you tried some NSAID to see if it settles with conservative treatment?