Saturday, October 8, 2011


I want to start with a comment on irony. I appreciate the comments on the last post and just thought y'all might be amused to learn this about me. The first job offer I had came from the man where I did my terminal preceptor. I turned it down for several reasons but probably the biggest was that his wife did the grooming / was office manager, his sister-in-law was the receptionist, and his niece worked in the kennel. I've always had worries about such strong family oriented businesses. You know, you feel like you may become part of THE FAMILY from which there is no escape... My first job turned out to have similar issues since the stepdaughter was the office manager unbeknown to me at the time of accepting the position. The wife in that situation was the ultimate boss, too, even though she didn't work there physically. I have known the people where I work now for years and never would've guessed that this would happen. I do, however, have a very current resume and am keeping my eyes / ears open. Unfortunately, I won't be able to do much in the immediacy due to the necessity of being home but.....

Thought I would share a fun surgery story. We inherited a client who has a young Yorki that was diagnosed with a cruciate rupture at another local veterinarian's office. The owner took time off work then found that the other vet wouldn't be able to do the surgery during that time so she called my boss who told her that we could take care of it. I examined the dog who did have a beautiful cranial drawer on the right leg then anesthetized it. All I can say is that it is a good thing I'm comfortable with improvisation.

I approached the leg as I would to perform a lateral suture but stopped because with the leg completely relaxed I could actually feel the patella (kneecap) and it was sitting on the medial aspect of the leg with the tibia rotated medially and neither would move to the correct position. I then altered my approach slightly and found that the cruciate ligaments were intact and there was absolutely no patellar groove in the femur. Instead, there was a mound of bone and the tendons were so contracted that the patella couldn't even be moved into an appropriate alignment.

Instead of a CCL repair, I got to create a new groove for the patella, transpose the ligament to a correct position thereby straightening the tibia, and then tighten the joint capsule so that it would all stay put. It was rather fun for a change although I prefer soft tissue surgery over orthopedics, hands down. My reason? Probably partially because I'm more comfortable with it but also because I find that no matter what I do, orthopedic surgery turns into hamburger and I can make soft tissue procedures look really pretty... And in this case, it's not just me. My orthopedic procedures actually look a little less like hamburger than the boarded orthopedic surgeons I've worked with thus far.

I also had a lot of fun explaining all of this to the owner. I even pulled out a great knee model and was about to take her to the chalkboard painted door to draw but she stopped me... :(

The only worry I have is that the owner won't do his PT like I demonstrated because she may be afraid it hurts too much. Then I'll have another like the last FHO that has a habit of holding the leg and has now built up scar tissue. That one has been frustrating. The dog had a traumatic coxofemoral luxation that was reduced closed then failed to stay in. I was trained that if it didn't stay in well during reduction, go on to an FHO rather than waiting. In this case, it was replaced multiple times and had cross pins placed through the femoral head once but still fell apart. I then did an FHO that I wasn't 100% happy with because there was a small piece of bone I would have preferred to have removed. When I discovered this, however, it was at the post-op radiographs and the dog had great range of motion with no bone interference therefore I opted not to re-open the site. Since then, the owner failed to do the PT and now the dog has such severe scar tissue formation I don't know if we'll ever get her to use the leg properly. At this point, we are sedating her periodically to stretch the leg and break down the scarring and she is wearing ankle weights to strengthen as well as fatigue the muscles in hopes it will help. Still waiting to see what will be the final result. We almost re-operated but when we anesthetized her and took more films the bone is remodeling perfectly and with a lot of pressure we could still make the leg go full range of motion after forcing the scar tissue to give; still no bone interference.

I wish I had the capability to bring them into the office (and owners would cooperate) to do some PT myself. Time is the major factor because I would be complained at about taking so much time for what would be perceived as too little income. Especially since I think we should increase our surgery price but let it include x number of PT sessions. Oh well. No one wants to listen to the new kid especially when it involves change!

1 comment:

foffmom said...

People go to PT after their shoulder repairs and their total knee replacements, and still a small percentage of them come back to be put thru a forced range of motion under general anesthesia. I haven't looked at any studies on this, but common knowledge attributes this to the "wuss" factor.
I think your idea is a good one, but as a pet owner I would like the option not to have/pay for therapy if I could demonstrate my ability to do it with my pet to your standards.
And of course, everyone would want the same lower cost, only some wouldn't do the therapy, and you'd be right where you are now.