Luxating Patella Surgery - Do Both Knees At The Same Time? Or One?

[pstinard]

Originally Posted by Gew

Hi,
Last Thursday I scheduled surgery for our little Max. The doctor said that both his knees were very bad, but the right the worst. He recommended surgery on the right asap. I asked if we could do both. He said yes but that it would be very hard on Max. He said he wouldn't be able to walk at all for awhile. I said my reasons for wanting both and he agreed to do both this Tuesday.

However, I kept reading and reading and decided I had picked our surgeon because he has done great surgeries on another dog (CCL), and called and talked to the surgical nurse saying I would prefer both, but I would rely completely on his decision. I am trusting he will make the right decision and consider that Max has active Lymes being treated, just had major dental surgery four weeks ago including 12 teeth having to be extracted before we adopted him three weeks ago and his age, seven or eight years old.

All of your opinions above really make me doubt my call to the surgeon. Please send good thoughts to Max on Tuesday. He is a doll, sweet and so loving. I would appreciate any advise to make him as comfortable as possible.

Thanks. I apologize if I made this all about me and Max, but this discussion was so right on as to our situation. I am so scared.

Gew

If it was me, I would heed the surgeon's advice and have only one knee done at a time. However, if he is willing to do both, then I guess it will be okay. I trust that the surgeon will perform a physical exam and do bloodwork before the surgery to make sure Max is up to having surgery done on him on Tuesday. Please keep us updated as much as possible as the surgery and recovery progresses.

For post-surgery comfort at home, we lined an x-pen with plenty of soft warm blankets and set it up next to us at all times so we could attend to Bella's needs. Since Max won't be able to walk at all for a while after his surgery, you will need to carry him to do his potties. Since Bella is pad trained, this was very easy for us to do--we carried her to her potty pad in the kitchen nearby. Since she had only one leg operated on, she could support herself on her good leg and squat to potty. If both legs are operated on Max, you will have to support his back side when he potties.

Bella lost her appetite due to the pain and the pain killers, so we had to be creative to get her to eat and drink. We made home-made chicken broth with NO fat and NO added salt, and put that in a bowl for her to drink. She would not drink plain water or pedialyte--it simply did not appeal to her. We also soaked her kibble in the broth, although you could go with canned food if Max likes it. Bella could stand on her three good legs to eat. If Max has both legs operated on, you might have to support him or be more creative in feeding him.

Max will have to wear an Elizabethan collar. The surgeon will probably give you a hard plastic cone. Bella absolutely hated it because it was uncomfortable and dragged on the floor. We bought her the soft inflatable E-collar that you see in the photo I posted earlier. It is much more comfortable, and she could use it as a pillow.

Me and others in Yorkietalk will be happy to give you advice on how to handle issues as they arise, but always keep in close contact with the surgeon during Max's recovery.

[Lovetodream88]

Originally Posted by Gew

Hi,
Last Thursday I scheduled surgery for our little Max. The doctor said that both his knees were very bad, but the right the worst. He recommended surgery on the right asap. I asked if we could do both. He said yes but that it would be very hard on Max. He said he wouldn't be able to walk at all for awhile. I said my reasons for wanting both and he agreed to do both this Tuesday.

However, I kept reading and reading and decided I had picked our surgeon because he has done great surgeries on another dog (CCL), and called and talked to the surgical nurse saying I would prefer both, but I would rely completely on his decision. I am trusting he will make the right decision and consider that Max has active Lymes being treated, just had major dental surgery four weeks ago including 12 teeth having to be extracted before we adopted him three weeks ago and his age, seven or eight years old.

All of your opinions above really make me doubt my call to the surgeon. Please send good thoughts to Max on Tuesday. He is a doll, sweet and so loving. I would appreciate any advise to make him as comfortable as possible.

Thanks. I apologize if I made this all about me and Max, but this discussion was so right on as to our situation. I am so scared.

Gew

I would not do surgery until he has completed the Lyme antibiotic because his issues could be from the Lyme more then the LP. Did you talk to the surgeon about the possibility of ccl tears and the wear and tear already on the ccl about how it's still likely to tear after surgery and cost you another couple thousand dollars to fix, another painful procedure, and another 8 week recovery? I am telling you because I have been there and I think you are making a mistake. I chose not to listen to a very wise women about it and she was very right.

[pstinard]

Originally Posted by Lovetodream88

I would not do surgery until he has completed the Lyme antibiotic because his issues could be from the Lyme more then the LP. Did you talk to the surgeon about the possibility of ccl tears and the wear and tear already on the ccl about how it's still likely to tear after surgery and cost you another couple thousand dollars to fix, another painful procedure, and another 8 week recovery? I am telling you because I have been there and I think you are making a mistake. I chose not to listen to a very wise women about it and she was very right.

Hi Taylor. Good point about the Lyme disease treatment. I hope the surgeon took this into account.

I reviewed this thread to get all of the relevant info and saw where you mentioned the possibility of CCL tears following luxating patella surgery. Could you explain to us more about why this happens, and if it's a possibility, then what other courses of treatment should the OP consider? The most obvious is (1) wait until the Lyme disease treatment has run its course and see if the symptoms improve first. After that, would you recommend that the surgery be postponed until there is a CCL tear and then do both luxating patella surgery and CCL repair surgery at the same time? In the case of my Bella, we caught her luxating patella early (at one year of age) and had the surgery done well before CCL injury was a possible issue, so I don't have any experience with CCL tears.

To the OP: I know that you're already worried sick about Max, so please don't feel that we're ganging up on you. There are a lot of experienced people in Yorkietalk, but ultimately the decision is between you and the surgeon. We're just giving you a few more things to bring up with the surgeon so you can make the most well-informed decision possible.

[ladyjane]

If you didn't go to a board certified orthopedic surgeon, I strongly urge you to do so. If you did, then I strongly urge you to get a second opinion from another one!!!

This does not sound like anything the surgeon I use would do.; and he is a very well known, highly respected surgeon. I have adult yorkies with LP and he would not recommend surgery on them. I have taken adults to him that walked funny, but he STILL didn't recommend it. As Taylor said, they already at that point have wear and tear on the cruciate ligament and will tear it anyway even IF the knee is repaired. Then, the pup goes through another surgery and it costs you even more money. It is RARE for LP to be painful....very rare. I have had multiple pups with varying degrees of LP...as a matter of fact some of my older ones do. IF they tear the CCL then I will have that repaired and the knee then of course.

It sounds to me as if you are not even sure if this pup is yelling out due to his knees. You mentioned his back end. Has his back been checked? Honestly only a MRI will show some of the spinal issues that can cause periodic yelping like that... and that is ridiculously costly unless there is a major issue.

Also, the Lymes....my goodness. I am honestly shocked any vet would recommend surgery if this is going on....but, I am not a vet and only expressing what I feel as a pet owner and as a rescuer who has cared for many, many yorkies. I never shy away from necessary surgeries...anyone on this board can tell you that. But, I also am not one to jump in without knowing FULL well if this is the problem AND the fix.

Please, tread slowly here. Think...get more opinions...and think again.

[ladyjane]

AND, let me add that joint inflammation and pain is common in Lymes.

Again, please, please rethink jumping into this surgery. I think there are concerns here.

[pstinard]

Originally Posted by ladyjane

If you didn't go to a board certified orthopedic surgeon, I strongly urge you to do so. If you did, then I strongly urge you to get a second opinion from another one!!!

This does not sound like anything the surgeon I use would do.; and he is a very well known, highly respected surgeon. I have adult yorkies with LP and he would not recommend surgery on them. I have taken adults to him that walked funny, but he STILL didn't recommend it. As Taylor said, they already at that point have wear and tear on the cruciate ligament and will tear it anyway even IF the knee is repaired. Then, the pup goes through another surgery and it costs you even more money. It is RARE for LP to be painful....very rare. I have had multiple pups with varying degrees of LP...as a matter of fact some of my older ones do. IF they tear the CCL then I will have that repaired and the knee then of course.

It sounds to me as if you are not even sure if this pup is yelling out due to his knees. You mentioned his back end. Has his back been checked? Honestly only a MRI will show some of the spinal issues that can cause periodic yelping like that... and that is ridiculously costly unless there is a major issue.

Also, the Lymes....my goodness. I am honestly shocked any vet would recommend surgery if this is going on....but, I am not a vet and only expressing what I feel as a pet owner and as a rescuer who has cared for many, many yorkies. I never shy away from necessary surgeries...anyone on this board can tell you that. But, I also am not one to jump in without knowing FULL well if this is the problem AND the fix.

Please, tread slowly here. Think...get more opinions...and think again.

This is the voice of experience here, and I would take these recommendations very seriously. One other thing that concerns me is that the doctor recommended that only one knee be operated on, but was willing to do two at the patient's request. Also, I'm not convinced that the yelping is due to luxating patella, what with other possibilities being out there, such as the Lyme's disease or back issues. I second the recommendation to get a second opinion.

[ladyjane]

Let me share a recent story. Someone contacted me about their chi who was having issues with her knees. A vet said it was LP and recommended surgery. He was referring this person to a regular vet who "specializes" in knees. I told him to get the opinion of a boarded surgeon and gave him some names. He ended up using one that I recommended and guess what!!! The poor pup had fluid on the knees and an auto immune disorder ( I am not sure they even know for sure what it is ... I have not seen the records so have only been going on what the owner tells me ) Bottom line....NO surgery needed!!!!! The pup is on meds and improving..........

I STILL cannot believe there was fluid on the knees and that vet didn't know it.

[Lovetodream88]

Originally Posted by pstinard

Hi Taylor. Good point about the Lyme disease treatment. I hope the surgeon took this into account.

I reviewed this thread to get all of the relevant info and saw where you mentioned the possibility of CCL tears following luxating patella surgery. Could you explain to us more about why this happens, and if it's a possibility, then what other courses of treatment should the OP consider? The most obvious is (1) wait until the Lyme disease treatment has run its course and see if the symptoms improve first. After that, would you recommend that the surgery be postponed until there is a CCL tear and then do both luxating patella surgery and CCL repair surgery at the same time? In the case of my Bella, we caught her luxating patella early (at one year of age) and had the surgery done well before CCL injury was a possible issue, so I don't have any experience with CCL tears.

To the OP: I know that you're already worried sick about Max, so please don't feel that we're ganging up on you. There are a lot of experienced people in Yorkietalk, but ultimately the decision is between you and the surgeon. We're just giving you a few more things to bring up with the surgeon so you can make the most well-informed decision possible.

LP puts strain and wear and tear on the CCL. When you get it done young like a year old that strain and wear and tear is not bad. In fact if you feel like you should do LP surgery it is best to do it at a young age. As they get older the CCL gets more and more strain. You can fix the LP but the CCL will still have wear and tear. Callie had a partially torn CCL so we fixed the knee when they did the CCL. Two years ago I thought her LP was bothering her so I went ahead and did surgery on it even though I was told the risks and didn't listen. Well a year later the CCL tore in the knee I just did a year ago and wham back in surgery to repair that. It's painful and its 8 to 12 weeks recovery time plus thousands of dollars so it shouldn't be taken lightly. I feel the person is making a terrible mistake that is going to end up just like mine did. I also worry about complications because the dog has Lyme right now. I would wait until the Lyme treatment is done then see how the leg is. I would also use joint supplements.

[Gew]

Max takes Dasaquin, a glucosamine/chonfrotin supplement.
Gew

[Lovetodream88]

Originally Posted by Gew

Max takes Dasaquin, a glucosamine/chonfrotin supplement.
Gew

It takes about 6 weeks to build up. Did you read all the other stuff?

[ladyjane]

There is an awesome vet hospital in Red Bank. Would you be willing to travel?

[Lolasmom1211]

I'm just now getting a chance to read all of these posts and I, too, think you need to take a deep breath and look at all of the options. First of all, I see how much you love this little guy and want to do the right thing for him...but certainly you don't want to rush into an unnecessary, painful surgery. I've just left my 8 week follow-up visit with my 8 yr old male's 2nd ACL repair surgery and even though we had good news, it's not an easy surgery. He had his first surgery on his other leg 2 years ago. I would not even attempt a surgery with any other extenuating circumstances such a treatment for Lyme disease at the same time. Secondly, my guy never screamed out in pain - not once. I know each and every pup is different, but I'd have to completely rule out everything else before I let someone cut on my dog's leg, much less both. Have they 100% ruled out the possibility that this is NOT associated wih Lyme disease? Have they checked for a possible disc problem? I have a little female Yorkie that has just been seen by neurology with a disc problem that did scream out in pain; that for a split second I thought was LP, then perhaps seizures and after going to several different vets, was finally diagnosed as degenerative disc disease. BUT, it took several different opinions before we got there! Please get a second opinion, as Ladyjane suggested, at the vet hospital in Red Bank - I'd always rather be safe than sorry - especially when it comes to these tiny little babies. Bless you for taking care of this sweet boy. Please keep us posted...

[ladyjane]

I see you were online today, but didn't comment. I do hope for your pup's sake you have put off this scheduled surgery for tomorrow.

I am praying you have made an appt for another opinion. I just re read what you posted about your vet saying how hard this will be on him.....I don't know what your reasons are but I am praying he doesn't suffer. I am not against doing both knees on a pup...I have certainly done that...but again only letting a boarded surgeon do it.

[Gew]

I appreciate all the opinions and especially those who shared their experience with the condition. May I just review the steps that brought me to this point.
The luxating patella was noted on the day after we got Max. Our regular vet noted this was not unusual. Soon after, Max when running would sto suddenly with a loud yelp. We counted three or more for two days. We made an appointment and returned to my reg. Vet. I didn't know what caused the pain. I thought maybe a bladder stone or something. She examined him and manipulated his leg resulting in that yelp. The surgeon in the practice came in and referred us to a board certified surgeon at Valley Central where we had our Icy's CCL done very successfully. He did radiographs, etc. he said both knees were very bad, but the right, the worst. He suggested surgery and scheduled it for tomorrow. In the meantime we took Max to Red Bank to see their surgeon. One of my collies had a cancer on her nose treated there. The surgeon reviewed the X-rays and tests and said that only surgery would relieve his pain. He said the right should be done immediately and that the left would need it shortly. He proposed that a double surgery is very rough, but certainly in Max's case a possibility.

I am not a surgeon. Therefore, he will decide whether it should be one or two legs tomorrow. This is not something I look forward to having done. Little Max has been here only three weeks. We all adore him. I would like to thank those who shared their opinions and thoughts. I am very aware some of you think the surgery is a mistake, but every doctor, four in all, including two board certified surgeons think it is necessary. I lost one of my collies in July and my husband last year. I never thought adopting a senior would become so stressful or expensive. However, Max is a dear member of our family. I will do everything I can to make this painful time bearable during his recovery.

Time to remove the water and tuck the boy in.

Gew

[ladyjane]

Originally Posted by Gew

I appreciate all the opinions and especially those who shared their experience with the condition. May I just review the steps that brought me to this point.
The luxating patella was noted on the day after we got Max. Our regular vet noted this was not unusual. Soon after, Max when running would sto suddenly with a loud yelp. We counted three or more for two days. We made an appointment and returned to my reg. Vet. I didn't know what caused the pain. I thought maybe a bladder stone or something. She examined him and manipulated his leg resulting in that yelp. The surgeon in the practice came in and referred us to a board certified surgeon at Valley Central where we had our Icy's CCL done very successfully. He did radiographs, etc. he said both knees were very bad, but the right, the worst. He suggested surgery and scheduled it for tomorrow. In the meantime we took Max to Red Bank to see their surgeon. One of my collies had a cancer on her nose treated there. The surgeon reviewed the X-rays and tests and said that only surgery would relieve his pain. He said the right should be done immediately and that the left would need it shortly. He proposed that a double surgery is very rough, but certainly in Max's case a possibility.

I am not a surgeon. Therefore, he will decide whether it should be one or two legs tomorrow. This is not something I look forward to having done. Little Max has been here only three weeks. We all adore him. I would like to thank those who shared their opinions and thoughts. I am very aware some of you think the surgery is a mistake, but every doctor, four in all, including two board certified surgeons think it is necessary. I lost one of my collies in July and my husband last year. I never thought adopting a senior would become so stressful or expensive. However, Max is a dear member of our family. I will do everything I can to make this painful time bearable during his recovery.

Time to remove the water and tuck the boy in.

Gew

I am relieved to hear you are using a boarded surgeon...and that Red Bank has reviewed this. They are awesome!

I am very sorry about the loss of your collie...and your husband.

Best wishes to Max tomorrow...will keep him in my prayers. He is lucky to have someone to love him so much....not everyone takes these seniors in...thank you for taking him in and seeing that he has the best of care. <3
Please let us know how things are going.

Oh...and thank you for updating...I was so concerned.