Hard Decisions -- Need Help!

[TinaM]

Okay, my husband took Murphy down to San Diego today to the original OS. She has had time to review the x-rays and the prognosis from the Rehab place that basically told us to just put him to sleep. We still have an appointment to send him up to LA next Thursday to the rehab place that would board him and have made all kinds of promises without actually seeing him. They also said luxated patellas could be fixed with rehab and were not surgically necessary. So today's OS did not admit any liability or even say she did anything wrong. She did however give us new information that she has never mentioned before. Apparently Murphy has a genetic angle to his tibias that would have caused him to rupture his ACL's regardless of what we did and this is the cause of the failing LP's. She disagreed with the missing bone and said since this surgeon did not see his original x-rays he has no idea that this is the normal structure for Murphy. She said he really has just had the perfect storm of complications which have caused him to stop wanting to get up and the continued muscle atrophy has just further complicated everything. The right leg that everyone, including her just 30 days ago said was 100% now has a Patalla Alta which means it is leaning towards the right. This was caused by the fracture healing imperfectly and causing it to go out of alignment just a slight bit so that everytime she saw him she did not notice it. The left leg has such terrible muscle atrophy that the LP surgery failed. So without admitting anything she offered free surgery, free anesthesia and free boarding for 4 to 6 weeks for each surgery. We would have to pay for all rehab services @$100.00 a day, x-rays and meds. She would send him home for one month in between the two surgeries. She made it clear she couldn't make any promises, but she was not yet of the decision that putting him to sleep was the answer. She said if this approach doesn't work than she would give us her honest opinion about his future quality of life.

Keep in mind the sight unseen rehab place said to stop all surgeries immediately and dogs could recover from LP's with Rehab alone. She was very confident in her approach, but of course has yet to see him or evaluate him. The cost would actually be a bit more with the non-surgical approach. So what would you guys do? My husband said he would leave the decision up to me. I'm torn about putting him through any more physical pain. It just kills me to think about how many times he has been cut open since last May. Help!

 

[wrknnwf]

I'm at a loss for words that might help, but I think I would let the rehab evaluate him before just buying into the vets recommendation. I think you need as many opinions as you can get in this particular case.

But I'm confused, too. The rehab said to put him down and then said they could fix it? Did I read that wrong?

 

[Erika]

I dont have any advice........those decisions are tuff..sending prayers and angels for everyone

 

[KatieB]

Tina I think I'd ask the rehab place a lot more questions about what they'll be doing. You were already taking him to extensive rehab right??? So what is this place going to do that is so drastically different from what your current rehabilitation place? This is such a tough spot to be in but I would probably do the surgeries....but knowing the surgeon and the facility probably biases me a bit. If he's really in as much pain as you describe it's going to be difficult for any therapy to build the large amounts of muscle he would need to support himself, but it certainly is worth further questions before you make a decision. I know whatever you decide will be best for Murphy and just feel so bad for you both. Big hugs to you and to him...keep us updated on how he's doing.

 

[BoundlessNewfs]

You mean he'd be away from you for both surgeries and rehabs? Do you get to visit while he's there? I'd be afraid he'd feel abandoned.

This is a tough call. Do what you can to keep him going, but it comes down to just how much is this going to help, and what will his quality of life be afterward? What about "prehab" (physical therapy PRIOR to surgery, to build him up and get his circulation going again)? The surgery would be more successful, I would think, if his circulation is improved, first. When the muscles are atrophied like his, his circulation is most probably very poor, also.

Tough choice. Let us know what you decide.

 

[TinaM]

I'm at a loss for words that might help, but I think I would let the rehab evaluate him before just buying into the vets recommendation. I think you need as many opinions as you can get in this particular case.

But I'm confused, too. The rehab said to put him down and then said they could fix it? Did I read that wrong?

sorry for the confusion. We live in Orange County, the OS is in San Diego. It was not close enough for rehab so we took him to a local place for rehab. They also run a surgical speciality hospital. They told me that rehab was making him worse, after x-rays said to put him down. We found another rehab place in Los Angeles that offered some hope without actually having seen him. They require us to board him up at their facility for 6 to 8 weeks. So we took the x-rays from the OC Rehab place to the original OS and she offered us the above surgical alternative. I know it gets really confusing. I hope that simplifies things. He has yet to see the LA rehab facility. They were recommended by the Wheelchair company because he doesn't want to use the wheel chair either.

 

[TinaM]

You mean he'd be away from you for both surgeries and rehabs? Do you get to visit while he's there? I'd be afraid he'd feel abandoned.

This is a tough call. Do what you can to keep him going, but it comes down to just how much is this going to help, and what will his quality of life be afterward? What about "prehab" (physical therapy PRIOR to surgery, to build him up and get his circulation going again)? The surgery would be more successful, I would think, if his circulation is improved, first. When the muscles are atrophied like his, his circulation is most probably very poor, also.

Tough choice. Let us know what you decide.

We were trying to build up the muscle by putting him in the OC Rehab facility. This is the hospital that said rehab was making his right leg worse and he was just genetically predisposed to complications and the best decision for him would be to let him go. So we have kind of gone this route already. The place in LA was really to help us to get him to use the wheelchair since the OC Rehab place didn't think this was sufficient quality of life. They basically gave up on him. The Los Angeles place unsolicited offered to get him walking without the wheelchair and made amazing promises without actually evaluating him yet. That evaluation is to take place next Thursday. They take a more holistic approach and actually do not have any vets working at their facility. They treat through diet, acupuncture, massage and water therapy. I am a bit leery of the non-surgical approach, given the lack of medical training or expertise at that facility. The original OS has been very honest this time about not being able to guarantee a positive outcome. She is hoping by having rehab services immediately following surgery for several weeks that this will give him the upper hand he has lacked in the past. It is a really hard decision.

 

[KodysGrandma]

I don't know if this will help you in any way and for sure I don't know anything about the exact problems you're facing with Murphy. However, I think dogs are similar to humans in that some of them have more drive and push than others A few years back I needed knee surgery. I knew the rehab would be very difficult, not for me, but for my husband who would have to look after his business, the house, 13 dogs and to some extent me. Therefore I pushed the OS over his strenous objections to do both knees at once so all this only took place one time. After 2 or 3 sessions when I finally convinced him it had to be that way and when he finally agreed I sprang the trap. BTW I have Achilles tendonitis in both ankles. If surgeons ever can be said to freak he freaked. "You can't do the rehab, it won't be possible". Me- I'll do the rehab, don't worry. Back and forth. He stuck me in some orthopedic boots (both feet) for a couple of months and we went at it. I left the hospital in 3 days and only because he was worried about the dogs knocking me over did I go to rehab. Stayed there 5 days, driving in 2.5 weeks, back to work in 3.

Point being- drive makes a big difference. You may have read the thread here about the Katrina horse who lost a leg. R Taft has some knowledge I believe of animals and how they react to things like this. If Murphy has the will you can figure out which will be best.

 

[noblenewf]

Tina, I don't know this original surgeon but if it were me in this situation...and my dog...I would NOT go back to the original surgeon. There have been too many "hurdles", if you will, to get over as a result of the original surgery. That would definitely have me questioning the original surgeon's ability. I don't care how much she is offering to do for free, I would do what it takes to get my dog back to a functional level...even if that meant spending more money to go to a different surgeon. It just seems that this has been one complication after another...and I'm not so confident that it isn't the fault of the surgeon. I don't know the specifics, so I hate to sound judgemental, but I would definitely be leary about that surgeon touching my dog again...let alone operating on him. I don't know that I would trust the promises of the rehab facility either...especially since they are making promises without having seen and evaluated Murphy. If I were you, and I was in this situation...I would take my dog to the most qualified surgeon possible and see if any of this blotched mess can be fixed. Murphy is young, he deserves that. I can't imagine how hard this is for you and your family, and especially Murphy. I will continue to pray for him and all of you that he finds some relief soon and can live a life with some sort of quality. I know this must be devastating for you. Perhaps I don't know the complexities of the problems now...but considering his age I would do whatever it takes to try to make it better. And get him some pain relief soon. Keep us posted. We will support whatever you decide!

 

[noblenewf]

P.S. I, too, am not keen on the whole leaving him for a month idea. If he's anything like my Newf...he would go into a deep depression without me around.

 

[TinaM]

If I were you, and I was in this situation...I would take my dog to the most qualified surgeon possible and see if any of this blotched mess can be fixed. Murphy is young, he deserves that. /QUOTE]


Again, this is what makes this so difficult. We did take him to the biggest and best ortho facility in Orange County. We paid $600.00 for x-rays and an opinion letter on what to do to make him ambulatory. This is the doctor that said if it were him, he would remove the TTA on the left leg and put in a bone graft and "major hardware" to stabilize the leg. However, since he did none of the previous surgeries he refused to touch murphy. He said even his approach would have a less than 25% chance of success and instead said we need to make an immediate "quality of life decision". He thought Murphy was prone to complications and we should put him out of his misery. His alternative approach was to give us the x-rays on CD and referred us back to the original OS with his opinion letter. He himself refused to touch our dog surgically. It seems like a catch 22!

 

[Jeannie]

I don't have anything to offer except my prayers. I'll pray for wisdom on your part and healing for Murphy. I'll also pray that you have peace with whatever route you choose.

 

[lilly06]

IMHO you need to get Murphy to UCDavis. I would be more than happy to help you and your family. I live about 20 minutes from UCD. PLease PM me if you are interested with my assistance. Please give them a call. Given that we have had similar complications with our newfs. I can not say enough positive things about UCD. I only wish I would have known how to get Lilly there previously. We might not be going through what we are now.

I am leary about the PT place trying to evaluate him over the phone. I would think that the rehab for the LP's would depend on the degree that the LP's are luxating. Initially, Lilly's patellas were out permanently and we tried to take her to PT. The PT was very very concerned because Lilly was basically crippled. Put a 120 lbs on a dog and no knee caps you got issues. The tissue holding the patella was totally stretched and the OS had a 4 hour surgery trying to keep the LP in place. Right now, I think that one of Lil's left patella is still luxating a bit. Not sure because she still has swelling from the plate/hardware removal. She is bearing weight. I believe with PT her gate will be fixed and that is what I have been told numerous times.

Rexanne & Newfs Lilly & Noche

 

[cedarvalleynewfoundlands]

As far as the Rehab place, I would be extremely skeptical of anyplace that made any sort of diagnosis or promises without ever seeing Murphy. Just think of yourself, you couldnt call a new doctor you had never seen and have them tell you anything over the phone. Mistakes can and do happen in surgery, even if you have the best surgeon available. In reality, they are depressingly common. I know in human medicine the surgeons will never admit to the family that they made a mistake. This is for medical malpractice reasons more than them being unwilling to admit it. Canine surgeons also have to worry about malpractice, which could be why the original surgeon is not admitting anything. For practical matters, her offering to do further surgery at no cost to you is probably as close as you are going to get to an admission of "guilt". Do you feel like she is a good surgeon? Anyone can have a bad outcome, even with top knotch surgeons. Usually really good surgeons in an area are well known by general practice vets in the area. Do some asking around and see what you can find out about other vets opinions of her work. If you think she is a good surgeon, I would look into what she is proposing to do and see what you can find out.I would take all Murphy's records and XRAYS and get a second or even a third opinion to see if they match what she is proposing. If you can get to UCDavis, I would definitely make them one of your second or third opinions. You should be able to take all his info and have a consultation with other surgeons for other opinions, much as we can get second opinions from our doctors and surgeons.
Good luck, I wish there was a crystal ball you could look into and tell you what to do.

 

[rcantor]

Tina, best of luck. I know you can trust your judgement. Your heart is definitely in the right place. Take the time you need.

 

[R Taft]

I have to just put a little opinion in here..............I don't know the Surgeon, but from several posts I gather that the Surgeon is a good Surgeon and Murphy has some congenital issues that are part of the whole problem..................It is a shame that this was not discussed pre-surgery, as to maybe causing lower percentages for healing. Everyone has to remember that there is no 100% guarantee in Surgery. If this Surgeon is generally known as a good Surgeon, i would go with his options. he obviously has some positive reports or you would not have chosen him. Rehab only in structurally unsound structure/bone/tendons is unlikely to be the choice treatment. Supportive rehab is always good before and after......Swimming being excellent.
I still think human orthopedics is not too different to dogs. If Murphy goes to the vets facility you might also find that there would be equipment that would possibly help with his rehab. We have rehabbed horses with severe injuries and used slings, where we have lifted the whole horse from stable into swimming pools. this requires expensive equipment, cranes/lifters..............Maybe two can be done at ones?????
Also are you maybe allowed to visit him daily...........Say take some vacation time and be there with him during the day. It is what we allow in Hospitals with kids. The Surgeon might be amenable to that.
Again Murph's heart has to cope with all of this. i don't mean the physical heart, but the "mental" heart. In all our rehab animals with severe injuries, it has sometimes been up to the animal as to how far you can take them. We have had severe ugly injuries where we have had good end results. And some small injuries, where we could not save the animal. Only you, because you know Murphy, can make all the final choices.
:hugs: to you and Murph :hugs:
Ronnie

 

[zennewf]

As for putting Murphy thru more pain, surgery, and separation from family .... it would depend on each dog. I've had four newfs, and two of them (more emotionally resilient) would have been fine doing what you are are describing. The other two ... both very sensitive, had tough early lives, very home-based, would not tolerate the regime of surgery that Murphy may have. It sounds like Murphy can take it, he's young, and he sounds like a typical happy go lucky newf. But only you know that.

I say, if there is a shot with the surgery, I would try it. It's only a few more months to see if it will work and he's quite young. At this age, their bodies are very resilient.

The unseen rehab place ... sounds very pie in the sky, especially since we are talking STRUCTURAL, MECHANICAL bone issues. I am sure they are good at uncomplicated rehab, or rehab w/soft tissue, nerve or immune issues ... but structural bone issues ... you need an orthopaedic surgeon for those.

I think that I would chance it with the first, original surgeon. If she is highly regarded, and seems to have a plan .... I would take one final effort with her. She's familiar with the case and is highly invested in it. ALternatively, I would consider going to ucDavis where they seem to specialize in fixing surgeries that failed/went wrong/were botched.

I think you have to, for your sanity and for clear thinking, drop thinking about who's at fault, people admitting responsability,etc. It's not going to help Murphy.

Finally, if you feel that in the end it's best to put Murphy to sleep ... there is wisdom in that, too. You will know what is best for him. Not knowing him, I say go for the surgery with the original vet or check out UCDAvis and get third opinion. But only you know Murphy and just how much he can take.

Liz

 

[newfam]

Tina, I can't even imagine the stress and anxiety and pain you guys are feeling right now. Too much! I know it may not seem right but if I were in this situation, I would try a re-attempt with the OS. I know, like you and many others, this seems crazy. But if you think about it, the OS has all the information, i.e. original x-rays, original diagnosis, and they have 1st hand knowledge of the surgery that was done...all be it not that great of one. But like Ronnie stated above, not every surgery comes out 100%. If Murphy has congenital issues this would make it even more difficult for the surgery to succeed. As far as the rehab place that has such high promises, well I would take that with a grain of salt. People promise anything to anyone these days. I wouldn't completely eliminate this choice, but it wouldn't be my 1st. I would save it as another option should the surgery not be able to be performed for some reason or another. As far as the separation, yeah...that's a tuff one. But if you think about it, wouldn't you think it would be better for Murphy to rehab at a place with no distractions and all the knowledgeable people right there by his side. I would think it would be harder to rehab at home or near home. Sure he will be frightened, dismayed, confused, but if you are able to visit that would be great. If you aren't able to visit, then it would be one day at a time when he returned home. Dogs have an uncanny ability to remember their masters...I'm sure Murphy is no different. He won't forget you is what I'm trying to say.

Believe me, I know this is easy for me to write, and I only add it to help you. It truly pains my heart to hear these type of stories. I truly hope and pray for an amazing miracle for Murphy! May God shine his blessings upon you and Murphy today and throughout this ordeal. Keep you head up high and know that you are strong throughout all this! :grouphug:

 

[Bär]

I have been following poor Murphy's story with a heavy heart. It is very sad to see a young pup in that condition. Whatever you deceide, it will be for the best of your boy. You have to trust your heart.

 

[blackberry6]

I just want to say that you and Murphy will
be in my thoughts and prayers:hugs: