Why I didn’t follow the “gold standard of treatment”–TPLO surgery–for my dog’s torn CCL, and how she’s doing despite going against the vet’s recommendations.
“Uh-oh,” my husband said, as Faith came in from her morning potty break.
“What?” I replied.
“She’s limping, again,” he said.
We’d only been home one week from a trip to celebrate our grandson’s birthday.
The first day of that trip we noticed Faith limping after she came in from the backyard. We figured she’d hurt herself launching off the deck in pursuit of a bunny she likely saw grazing in the grass. It was March — nearly spring — but it was still bitterly cold in Ohio. We spent our two-week visit indoors, forgoing morning walks for a hot cup of coffee inside the warm house. The respite from walking was good for Faith. By the time we returned home her limp was nearly gone.
Faith was eager to resume her morning walks.
And because her leg seemed better, so were we. Faith is a pretty chill dog inside the house, but when she hears the word walk her eyes brighten, her ears perk up, and her whole body springs to life. She used to enjoy stalking bunnies in our suburban neighborhood. Now that we live in the mountains, it’s not uncommon to see deer, wild turkeys, rabbits, squirrels, and even the occasional groundhog on our daily walks. We love being surrounded by all the local fauna, and Faith loves it, too. She has a hard time containing her excitement whenever we see friends, as I often refer to them. She’s been known to scare off an entire herd of deer with nothing more than her pheromones.
Faith’s leg seemed fine until the morning my husband saw her hobble into the house after her potty break. Of course it was Saturday. My dogs always seem to get sick or injured when the vet’s office is closed. Considering she’d already healed her leg once, we decided to give it the weekend. I’d call the vet on Monday if she wasn’t better.
Monday arrived and Faith was still walking on three legs.
I called and scheduled a vet appointment for two o’clock that afternoon. Meanwhile, two fears swirled round and round in my head.
Osteosarcoma — bone cancer.
Faith is an eight-year-old golden retriever and goldens are prone to cancer.
We lost our previous dog — a golden retriever-chow chow mix — to hemangiosarcoma, a cancer that strikes without warning and usually results in a swift death. Our other dog, Hope, is one of 3,000 golden retrievers participating in a study focused on identifying cancer risk factors in dogs. Sixty percent of golden retrievers are affected by cancer. A fact I try not to think about on a daily basis, but I couldn’t brush it from my mind that morning.
At 1 p.m. my husband hoisted sixty-pound Faith into the backseat of my car and I drove her to the vet. We wouldn’t be seeing Dr. M., Faith’s regular vet. Our appointment was with another vet in the same office. The vet examined Faith’s right leg and recommended an X-ray. After sedating Faith, the vet tech walked her down the hall for the X-ray and I was left alone in the exam room, with only my worrisome thoughts to keep me company.
When the vet tech returned with Faith, she pulled up the X-ray image on the computer screen.
The vet would be there shortly she said, to review it with me. Although Faith was subdued, she was still anxious. I petted her soft golden fur to calm her. It calmed me, too.
The vet walked into the exam room and motioned for me to join him at the computer. He pointed to the black and white image on the screen and explained that the white cloudiness covering Faith’s knee joint was inflammation.
“She’s torn her CCL, which you may have already guessed.”
“That’s what I was afraid of,” I replied, relieved to hear it wasn’t cancer.
The CCL is the equivalent of an ACL in humans. It’s the ligament that holds the knee joint together. CCL tears are the most common injury in dogs. And, CCL surgery is the most common orthopedic surgery performed on dogs.
The vet explained that the gold standard of care for large dogs with this injury is a surgery called TPLO, and it costs three to four thousand dollars.
I tried, unsuccessfully, to hide my shock.
“Probably not what you wanted to hear, is it?” he said.
“What are our other options?” I asked.
“These injuries don’t heal without surgery. But, we could recheck her in two weeks, and you have her senior wellness exam scheduled two weeks after that. We can see how she’s doing in a month. In the meantime, we’ll get you an estimate for the surgery.”
The vet gave me a seven-page handout on Ruptured Cranial Cruciate Ligaments in Dogs.
Then the vet tech carried a very groggy Faith to my car, and we headed home to break the news to my husband.
I spent the rest of that afternoon, and most of the following day, reading everything I could find on CCL injuries and TPLO surgery. What I read horrified me. TPLO, an abbreviation for Tibial Plateau Leveling Osteotomy, involves cutting the tibia bone, rotating it, and securing the joint with a metal plate and screws. Recovery takes three to four months. I couldn’t imagine trying to keep my feisty Faith still that long.
This is the dog we caught doing zoomies in my daughter’s backyard after she injured her leg the first time. The dog that when people ask her age, I typically respond, “she’s eight… going on two.”
The next morning I received the following text from the vet:
Hello, we are checking to see how Faith is doing. The estimate for the cruciate repair with Dr. C. is between $3800-$4000, and he is booking about 2 months out. There would be an initial consult fee of $175.00. If you have any questions please let us know. Thank you.
That meant waiting three months — one month to see Dr. M., followed by two months waiting for surgery, if we decided to go that route. I couldn’t imagine restricting Faith’s activity for three months, followed by another three to four months after surgery.
My heart sank. What were we going to do with our poor injured girl?
In doing my research I’d read about an alternative to surgery called Conservative Management (CM). I decided to investigate it further. With my golden girl laying faithfully by my side, I spent another day poring over websites, veterinary studies, forums, and Facebook posts from pet owners who had healed their dogs without surgery.
I learned about custom orthotic braces, supplements I’d never heard of, and rehab protocols like red light and hydro therapy. I read posts written by worried pet parents whose dogs were suffering complications while recovering from surgery. Dogs having to undergo a second surgery to remove metal plates that had caused infection. The high prevalence of dogs injuring their other leg shortly after the first. Muscle atrophy from all the time confined to a crate, prior to and after surgery. And the kicker, according to the American Veterinary Medical Association, TPLO surgery increases the odds of bone cancer forty times.
My gut screamed loudly to my brain, “Surgery is not the right option for Faith!”
I knew whichever route we chose, it would take six to twelve months for Faith to fully heal. If we had to wait three months for surgery, we may as well try to start healing her now.
I emailed the vet’s office to let them know we were going to try CM and a custom brace. I cancelled the follow up visit and said we’d see Dr. M. in a month for Faith’s senior wellness exam.
Faith’s pretty purple brace — to match her purple dog collar — arrived a week later.
After a day or two getting used to having the padded metal and leather contraption strapped to her leg — my sister nicknamed her RoboDog—Faith was walking as if nothing was wrong. A few weeks into her rehab she’s her spunky self again, which tells me she’s not in pain. She’s back to daily walks — twice daily actually — and while life isn’t back to normal, it’s a pretty good substitute.
In addition to walks, we’re treating Faith with heated compresses, massages, and range-of-motion exercises. We’ve covered our slippery laminate floors with a trail of mismatched rugs and yoga mats. We’ve gated off the stairs and my husband built two wooden ramps so Faith can go outside to potty without having to climb stairs. At night she sleeps in her crate in the dining room, instead of downstairs in our bed. And we’ve put her on supplements that are supposed to aid recovery. Faith has willingly accepted all of these changes to her normal routine.
In the midst of all the trauma, something beautiful and unexpected is happening.
I’m forging a deeper connection with Faith. She looks at me differently these days. Her usual wild-eyed stare has been replaced with a calm, loving gaze.
My feisty little Faith has acquiesced to a calmer demeanor. She seems to understand and accept the changes. It’s as if she knows this is what we have to do right now, but it’s okay because we’re in it together.
We saw Dr. M. last week and she fully supported our decision not to pursue surgery. She seemed genuinely intrigued by the brace and eager to learn more about it. And, she was impressed with Faith’s progress and encouraged us to keep doing what we’re doing.
Coincidentally, during all of this, my right knee started hurting.
Sympathy pains? A romantic idea, but more likely it’s just overuse. I decided to follow Faith’s lead and take a break from exercise. On our daily walks I wear a compression sleeve. It’s not as pretty or supportive as Faith’s custom purple brace, but it seems to be helping. It’s only been a few weeks, but like Faith my knee is feeling better, too.
Faith is my seventh dog, and oh what a difference experience and maturity makes, as illustrated by this story about my first dog: What a Little Rescue Pup Taught Me About Pet Parenting, Life, and Love.
This story was originally written and published in The Narrative Arc on Medium, as an entry in the Furs and Feathers Writing Competition. If you’d like to read and applaud this story on Medium, you can do so here.