Back in the Game

                        It was only a routine play to the sideline. But when it was over, the player sat quietly on the grass, with a “help me” facial expression both acknowledging that something bad had happened, and disbelief that it did.

                        The fans were shocked, silenced by the sudden end of so much promise,  followed by that horrible feeling of what might have been.

                        Am I describing the play that took out Cleveland quarterback, Brian Hoyer, and all the hope he represented for long suffering Browns fans? Oh, my goodness, no! This was far worse than that. The player injured didn’t even play football. She played “ballie”, and although she had the same injury as Brian Hoyer, a torn ACL, she wasn’t a human. She was a dog. And not just any dog. The player hurt was our beloved Welsh Corgi, Betsy Louise. Moreover, in that instant her parents went from being veterinarians to owners of a broken pet, with all the concern and anxiety their clients might experience when faced with a similar situation.

                        What should we do? Surgery or medical management? We don’t do knee surgery in our practice, but we have treated several dogs, big and little, successfully with anti-inflammatory drugs, glucosamine-chondroitin sulfate medications, exercise restriction, and time. Betsy, however, was a special case. She was only two years old, and without question, the most athletic dog we’ve ever had.

                        Although our two Border Collies literally run circles around her when it comes to herding sheep and ducks, and Betsy does try, fetching the Kong ball is her specialty, and obsession. With her short legs and lightning reflexes, she makes the Border Collies look like the team that always plays, and loses to, the Harlem Globetrotters.

                        The knee or stifle joint, which connects the long femur bone to the shorter tibia and fibula bones of the lower leg, is one of the most complex joints in the body, subject to stress with each step taken; the stress exacerbated when running, jumping, and twisting is thrown into the mix. This is probably what got Betsy into trouble.

                        The joint is held together by two pairs of ligaments, which are fibrous bands of tissue, that link bone to bone. The medial and lateral collateral ligaments are located on the inside and outside surface of the joint. The anterior or cranial cruciate ligament and the posterior or caudal cruciate ligament hold the joint together from within.

                        If the anterior cruciate ligament is torn, as in Betsy’s case, the tibia is allowed to move forward unconstrained, which destabilizes the joint and can lead to further damage to the other ligaments as well as arthritis.

                        Betsy’s mother, Bonnie, consulted with two surgeons. One preferred a procedure known as Tibial Plateau Leveling Osteotomy [TPLO]. In this surgery part of the tibia is cut and rotated. It is more invasive, more complicated and thus more expensive. For larger dogs, though, it may be necessary. The other surgeon routinely performs the Lateral Imbrication technique, which involves tightening the lateral joint tissues with sutures. For smaller dogs like Betsy, this usually works fine, and is the route we decided to take.

                        As surgery day drew near, however, we were filled with additional nervous-owner questions. Were we doing the right thing? Would the operation be a success? And, of course, the whole idea of putting Betsy’s life in someone else’s hands, even when we knew he was perfectly capable, was another small mountain to climb.

                        The patient was to be dropped off at the animal hospital around noon. Bonnie made a list of Betsy’s likes and dislikes. Included was that Betsy liked to have someone’s fingers placed inside her ears, I guess for an internal massage. She also liked to have her chest rubbed, but not her belly. I did not know that. And please, if they could trim her nails real short while she was sleeping, as Betsy has never been keen about nail-trims. I knew Betsy liked to play by her own rules, but I didn’t realize there was an actual list. I appreciated the doctor and his technicians for the kindness and patience shown to me, the list, and Princess Betsy Louise.

                        Her surgery and recovery went well, and although she was pretty gimpy for the first few days, the sparkle soon returned to her eyes. With each passing day she becomes more like the Betsy Louise of old. Hopefully, in about three months, if her rehabilitation continues to go well, she can begin to think about getting back in the game.

Author:  Dr. John Jones