Poor Little Buddy

Poor Little Buddy

For the second week in a row, I have had to take Buddy to the urgent care vet because he was clearly off and in pain in the morning. Buddy is such a ball of fire usually that it is easy to tell when he is off because he does not run around and jump up with a toy in his mouth like he usually does. He gets lethargic and shakes. They say that dogs show pain by shaking. Both times, I have taken this shaky little fur ball into the vet’s office, a place he knows as well as any dog and the process of change has been very much the same both times. He starts by shaking more because he knows he’s going to get poked and prodded. Then his little body gives him a squirt of adrenaline and he’s back to being the morning Buddy we are used to. Both times the vet has given him an overall vitals exam and both times she has said that he has nothing visibly wrong with him except his congenital issue of hip dysplasia.

12% of all poodles are born with a tendency for hip dysplasia or an underformed rear hip socket where the socket is not deep enough to keep the hip in place all the time and which can become dislocated with minimal exertion. We have known that Buddy is in that 12%, but we have rarely seen any effects that would cause him discomfort for more than a moment or two. Buddy is approaching his second birthday and we think he is starting to have more problem with those hips and perhaps wake up in more pain that puts him off his normal morning routine. The vet told me point-blank that if he were her dog she would get his hips surgically fixed to solve the problem. Apparently the procedure involves the orthopedic surgeon shaving and deepening the hip joint so that the ball can more comfortably fit into the socket and have less chance of dislocating. She says that he would have both legs done in one surgery and that he would take some two or three weeks to recover. Kim and I have started talking about it.

Kim and I come at orthopedic issues very differently based on our respective experiences. Kim has two fifteen inch white scars running down the middle front of both knees where she had her knee replacement surgery a number of years ago. She says it is the best thing she ever did and feels that it has greatly improved her mobility and therefore her quality of life. Weak knees seem to run in her family as her brother, Jeff, has one artificial knee and another one that has been so surgically altered as to be something in between artificial and real. Her sister suffers greatly from troubled knees, but she has not gotten them surgically addressed. My knees are hardly perfect. I traumatized my left knee twice to the point of seeing orthopedists both time. That was thirty and thirty-five years ago and I have never had so much as an arthroscopic exploration of my knees. Instead, I used some version of physical therapy and a knee brace (specifically for skiing), and I did what neither orthopedist said was possible, which was to let them heal themselves. The first orthopedist (in Toronto) told me that ligaments do not heal when damaged. He thought my ACL was severed and should be replaced with Kevlar. I didn’t do it. When I traumatized the same knee five years later (and after five active ski seasons), an MRI (I would not allow this NYC orthopedist to do arthroscopic surgery with general anesthesia and and he was not willing to do it with a local) showed that my left ACL presented with a quarter-inch patch of scar tissue, which he said was the original injury. I asked how it was that a ligament would heal itself with scar tissue. He admitted that it does happen but that scar tissue is not as supple and that the ligament has greater range of motion limitations after scarring. Is it any wonder that I chose not to have any surgical procedure on that knee for the second time?

Strangely enough, my friend Michael, who lived in Northern New Jersey at the time said he had met an orthopedic surgeon at a neighborhood party. That surgeon had complained that people were not getting their knees “done” as much in the nineties as they had in the eighties and that it was impacting his business growth. It was all a humorous (no pun intended) business story to him. Imagine my surprise when Michael told me his name and I found that it was my very own NYC orthopedic surgeon he had been speaking with. Is it any wonder that my trust of orthopedic surgeons is not greater?

So, when I hear a suggestion that a cute little 5.5 pound Buddy needs orthopedic correction of both of his hip joints, I start off being a bit skeptical. It isn’t really about Buddy being a dog and my not wanting to sponsor an expensive orthopedic surgical procedure for a dog. Rather, it is a question I have about whether corrective surgery is always necessary whether in a human or a dog. I am better able to observe the pros and cons of this with Kim and her siblings. Clearly they have a congenital joint weakness not unlike our toy poodle. Clearly it impacts their well being and the full enjoyment of their lives by curtailing their activity. The oldest sibling, Kim’s sister Sharon has decided to just live with her knee issues and make the most of her life with her knees as they are. Kim’s brother Jeff has taken a very different path and has tried everything to correct his knee problems. I don’t have an exact count, but my guess is that he has probably had a combined dozen knee procedures. At one point, a particularly perplexed orthopedist suggested that AKA was called for. That would be Above the Knee Amputation. Jeff went in another direction. He now has one artificial knee and the one that got badly botched over time and is functional but pretty badly deformed and less robust. His path was an active trouble-shooting one rather than the denial and ignoring one and it had its challenges to be sure.

Kim somehow had the clarity of thought to decide early in life, at an age well younger than either of her siblings, to have the knees replaced. While the process of recovery involved plenty of therapy, she has never had anything but a positive outcome and improved mobility from her decision. Her example advocates for early and decisive corrective action. The least positive outcome seems to be to ignore the problem. But that is just the example of her particular family. No one in my family has had joint surgery and both of my older siblings and I are walking around just fine. The right decision for me was to ignore the palliative of surgical correction. So, what does all of this say for poor little Buddy?

I think I would dissect the problem by suggesting that like Kim’s family, Buddy comes with a genetic predisposition for an orthopedic weakness. He is a little guy with lots of spunk and he wants to be running and jumping all around the house from dawn to dusk. He’s an indoor dog who is still quite active. It would seem to be a major life curtailment to have him unable to be his full feisty self every day. That all says to me that we are going to have to look into correcting his genetic predisposition and have his hip joints surgically corrected. He can’t make that decision for himself as we all can, so its up to us to take care of poor little Buddy.