Sometimes in life your journey reaches a cross roads.
And if you're lucky, you have the support of a good friend and family to help you understand the choices.
Or at least to help provide a pleasant distraction from the decision that is looms ahead.
Sometimes it's important to ponder at the cross roads and consider the possibilities, explore the options and weigh the benefits of all the choices.
Knowing that some choices do not allow you to turn back.
Sometimes you have to just make the decision, knowing you've thought long enough.
So you close your eyes, and charge, full steam ahead.
For those who remember last year, Juno was diagnosed with hip dysplasia at only two years old, during her mysterious illness that was never really fully diagnosed. If you'd like to read about it, you can here:
This past month, I took Juno into the vet for her hip pain. She's been using acupuncture to manage the pain for the last year, she's now three years old, and it's worked magically for her. We chose acupuncture for a variety of reasons, but most importantly, we're not entirely sure if Juno has autoimmune disease in which her body cannot tolerate non-steroidal anti-inflamatories, such as metacam or even rimydal. So acupuncture has been the choice of pain treatment for her.
When we went to this vet, he looked at her x-rays which I brought with me, just hoping to catch him up with her information and get my referral to another IVAS-certified acupuncture veterinarian. The look on his face was grave. Oddly, I don't remember having the news told to me so gravely last year, but that could just be part of that Swiss culture of seriousness that I'm feeling.
He told me her hips were very severe and he seemed quite shocked that she could even move around as much as she does. He then informed me of our options, acupuncture being one of them for pain management. But then he told me this: of the three options for hip dysplasia surgery, total hip replacement was recommended earlier in dog's lives rather than later as they recommend in the US, when the pain is no longer manageable. Up until now, we had decided that we would put off any surgery until her mid life because we were informed last year that THR (total hip replacement) was not necessarily something that lasted a long time, only for about 6 years. Here, in Switzerland, the common recommendation is (if budget is not an issue for the owner) to do it earlier because younger dogs tolerate the surgery and recover faster. Also their spine is in better working order to be able to accept the surgery and there are no other structural complications they are facing. So far the vet's here have not heard of THR not lasting the lifetime of the dog. This was such a different opinion than the orthopedic surgeons and the advice of our vets in the US, whom I still love and respect dearly. I can't help but wonder if total hip replacement is so uncommonly done due to cost if there is enough real research done on how long it lasts as well as the recovery and other effects from it.
Admittedly, I have not done enough research yet. Anything I've googled has only explained the procedure and has mentioned it's success rate (good) but nothing about the long term effects, cautions or problems that could arise, which I have absolutely no way of really knowing except from those who've done it. And I just don't know anyone who's done it.
In the mean time, we've gone forward with our acupuncturist vet, Dr. Marmier, who we were referred to in Saint Prex. She's highly recommended and wonderful with Juno. She too was very grave when she gave her opinion about Juno's x-rays. Juno's been to her twice now and has felt better with each acupuncture needle. Dr. Marmier works with both the recommended orthopedic surgeon for THR in Lausanne, and Juno's primary care vet who happens to have an underwater treadmill for PT. Did I mention her primary care vet is within a two-minute walking distance from our house.? And did I mention how much I really like him and how much they really like our raw diet? Ya, I seem to jive with the vets here. I like the way they work together. Basically her primary care vet Dr. Tieche (who's office is 2-minutes from our house), Dr. Marmier (the holistic and acupuncturist) and Dr. Vingerhoats (the orthopedic surgeon) are a team with separate offices and specialties but work closely together. I was told Dr. Vingerhoats (what a nice dutch name, eh?) was one of the three who does THR and when a THR is actually done, all three vets do the actual surgery together. I'm not sure why other than it's probably not a surgery often done and that it's a learning experience for all three of them. The benefit to the pet is having three heads instead of one.
In any event, during our visits with Dr. Marmier, she told me Juno was a great candidate for "gold beads." Thinking back to Juno's mardi-gras yahoos, I'm like, ya, "Juno loves her jewlery, but she's more of a silver and platinum girl than gold." But that's not what she meant. The beads are a microscopic gold piece of metal, inserted surgically at the acupuncture points. They serve as a permanent, life-time anti-inflamatory to help deal with pain. If there's no pain, the dog can use the joint properly (forward and back motion rather than a swinging of the hips and spine to move the legs) and build up muscle to help hold the hips in place. Since Juno reacts so nicely to acupuncture, she thought it would be worth a try in order to avoid surgery if possible. Dr. Marmier has had a lot of success with gold bead treatment for hip dysplasia and often does not need to see the dog for 10 years after it is done. At least that's what she told me. Dr. Marmier is not against surgery, and in fact recommended it as an option for Juno. However she also cautioned that some dogs reject the prosthesis. That was the first time I ever heard that. I actually need to do a lot more reading on this subject and fairly soon. You see, if we want to do the surgery, the time would be now, while Juno is young, and can tolerate the surgery, anesthesia and while she still has little other damage to her body. As it is, there is some issues starting to develop in her low spine due to the improper movement of her legs and hips. Her vertebrae are getting looser and trying to fuse to stay in tact. I can also tell Juno has some issues with going to the bathroom now and then that has little to do with diet. Speaking of diet, this girl who once would eat anything that didn't move (or moved for that matter) is now becoming a bit pickier about her dinners sending me a signal that things aren't normal.
For now we opted with the gold bead surgical inserts, which were injected on Wednesday. She had to be under anesthesia in order for them to be injected. While she was out, they took more x-rays of her spine and hips. As expected, her hips are worse now and her spine is starting to show some bridging in the last vertebrae to help it stay stable. We plan to give this a month to see if the pain subsides enough for her to be able to use her legs properly. I"m supposed to "trot" her starting at 5 minutes and build up to 15 or 20 per day. I'm not so sold on that being what will build up her muscle since I've been walking her daily from 1.5 - 3 hours. But then again, we don't trot or jog.
So we have a month to see how things work out. After that, if she's not moving better or if she's still in pain, or shows compromise in her spine, we have to decide if we want to move forward with THR. And that's not an easy decision. The cost is not an issue. For us, it's the fear of making Juno's life worse after wards. What if she rejects the prosthesis? Did we make the wrong decision and shorten her life? What if we DON'T do the surgery will that be the wrong decision which inevitably leads to a shortened lifespan due to other complications that will likely arise due to structural damage? The fear I have of NOT doing surgery are all the other things we will face from the complications of the severity of her dysplasia. I already see a decline in her movements. Though I love to write stories about her "taking down the Big Boy" in wrestling matches, the truth is, Juno is so dainty and often shrinks away from Loki's playful advances as if she's afraid of getting hurt. Loki for the "MOST" part has been good. Occasionally he's a butt head and will chase her to engage her when she's in no mood, but for the most part, in order to play he ALWAYS handicaps himself and flips upside down in order for Juno to get a good hold of him. It makes me sad to see Juno unable to do what I'm pretty sure she'd love to do... run and tackle him or at least not shrink from his advances. I don't fool myself into thinking she'll ever be able to be quite as strong or normal as he is if we do have the surgery and it is successful. But I would hope it would restore enough movement in her to do some of the things she loves. All that aside, doing the surgery would not be easy on Juno's mental or emotional states, nor would it be on ours. We'd likely face a year of recovery, 6-months per hip as they are done separately. I would do that in heartbeat if I knew it had a very good success rate.
Right now, the three of us are still in the pondering of the options and we could use lots of input. If any of my readers out there has any opinion of THR, or any knowledge of it or experience with it, please leave it in the comments section. I'd love to find out more about it from experience mainly, not from Wikipedia or vets who are invested in performing the surgery. I'm willing to hear your opinions as well: good, bad or ugly. Feel free to tell me "are you crazy?" Right now, Mr. Wild Dingo and I need to hear it all.
In the mean time, here are some photos from our outpatient surgery of the surgical gold bead implants. I know, I know: let the "surgical implants" jokes flow! Go for it. Make us laugh!
After the one-hour surgery, Dr. Marmier holds Juno while Mr. Big Bucks pays the bill.
"To think I liked Dr. Marmier before all this! Hmph!"
"Pop! Are you crazy? Don't pay them! You should see what she did to my beautiful jodhpurs!"
Three incision points on her low back and 2 or 3 on each hip. No floof. It's so wrong.
I have to admit, I liked Dr. Vingerhoats, though I barely spoke to him since Dr. Marmier was handling our case. AT this point, Dr. Vingerhoats is serving as our radiologist and possible surgical consult. To give the shot for the anesthesia, they had us hold her (while muzzled because it's painful) and stay with her while she goes to sleep! I've never done that with any of my dogs at any of our vets in the US. Here they say it's better for the dog so she stays calm while she falls asleep.
"Finally heading home from that dog-awful place!"
"Are these LEATHER seats in Poppy's car? Don't you have to make a stop somewhere and leave me alone in the car for 5 minutes Mom? Tee-hee-hee."
Loki was happy to see her when she got home. On Wednesday she didn't eat at all. I just hope it was the effect of the anesthesia. On Thursday we had company she did eat a little but her belly let all our guests know she wasn't feelin' so well. A wide variety of unusual aromas surrounded her. So we braved the cold and left the windows open while everyone ate dinner. Because dog-fobid (according to our gracious guests) that I should put the dogs in another room.
"Princepessa, I made a little room over here for you if you want it."
"Maybe later Big Boy. I'm feelin' like I need a little space."
"Anything else I can do Princess?"
"How about getting me a tray of frommage and du pain... BEAUCOUP du pain, Big Boy. Comfort food is what I need right now."
"Jodhpurs or no jodhpurs, you're still my Princepessa."
"Don't you forget it, Studly."
Tonight when Mr. Wild Dingo and I got home from our shopping, she was much more chipper. I bought boiled chicken for her as I was planning to just feed her simply for a while. But she seemed back to her usual "I'll eat anything you got" self. And she was standing a lot more than usual. Who knows? Maybe the implants will work.