Tigger's recovery without surgery raised this question:
"If Tigger could recover so well without surgery from severely disabling ligament rupture, what about all
those other dogs that vets are insisting must have surgery?
--- Was Tigger's recovery some kind of miracle?
--- Or could surgery be unnecessary for many other dogs too?"
That question prompted me to look deeply into canine ligament injury and its treatment. I
have communicated with hundreds of vets experienced in treatment of these injuries, and researchers who have studied the results
of the different treatment options. I have spent many hours reading the research literature dealing with ligament injury.
In the years since this website was first established I have heard from thousands of people who have dealt with these injuries
in their own dogs about their experiences with surgery and non-surgical recovery.
I have reached these conclusions:
----That a large number of the surgeries done on dogs diagnosed with ligament injuries are unnecessary
and inappropriate.
----That surgery is often described to clients by vet-surgeons as a medical necessity in cases
where it is neither necessary nor the best treatment option.
----That the reasonably expectable results of ligament-injury-related surgical procedures
are often misrepresented by surgeons as being much better than they really are.
----That all the ligament surgeries, especially the bone-altering TPLO and TTA, have risks which
are often not disclosed to clients by surgeons.
----That non-surgical recovery, while very often the best treatment for dogs' ligament injury,
is frequently inaccurately portrayed or ignored in surgically-inclined vets' presentations to clients of the available treatment
options.
----That TPLO and TTA have become cash-cows for a number of veterinary ortho-surgeons who are
making huge profits selling these questionable procedures by misrepresenting potential outcomes and risks to clients.
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When a dog has been diagnosed with a ruptured, torn or damaged ligament, vets often recommend
immediate surgery. Some dogs do need surgery, but many will recover very well without surgical intervention
if given the chance. Don't rush to surgery. The way to determine if your dog needs surgery is to carefully
restrict the dog's activity for a period of 8 weeks as described on the 'Diagnosis & Treatment' page at this
website. Slow, continuing improvement during the 8 weeks will indicate that your dog can almost certainly restore
stability to the joint without surgical intervention. If there is not improvement in your dog's condition, then
surgery probably truly is appropriate unless there has been a misdiagnosis.
---- A non-surgical approach is often successful and is very low risk. While most dogs
who have surgery do recover at least moderately well, the risk of complications and poor outcomes is unavoidable. I
regularly get emails from people whose dogs were worse off after surgery than before. In
a great many cases where immediate surgery is recommended by a vet, surgery is not really necessary & a non-surgical recovery
would result in the best possible outcome.
There is no good reason to believe that at the time of diagnosis a quick decision must be made to have surgery.
Proper restriction of activity will minimize the risk of further injury to the joint while answering the question "Does
Fido really need surgery?" Any vet who pushes you to quickly agree to surgery should not be trusted.
When your dog has a ligament injury, the most comfortable thing to do is to accept the vet's
recommendation for surgery. It can be a relief to hand over the burden of decision-making to someone who seems to be
an expert. But it is not wise to be so trusting. You need to be cautious and skeptical, not blindly trusting.
A vet may have talked to you about your dog's injury as though surgical intervention is a universally
accepted medical necessity whenever there is a ligament injury. This is not true. For reasons brought out
elsewhere at this website, many vet-surgeons recommend immediate surgery as their preferred treatment for canine ligament
injuries despite the fact that non-surgical recovery using careful activity restriction is usually the best first-choice treatment
option for dogs of all sizes. If non-surgical treatment is not successful, surgery will still be available as a treatment
option.
Many surgeons state that "Large dogs always require surgery when they tear these ligaments"
or "If a complete rupture rather than a partial tear is diagnosed, then surgery is necessary." You may see
other websites which unquestioningly accept such statements and repeat them as though they were proven facts. But these are
not facts. When I dug into the research literature looking for evidence that would back up such statements, I found
only low quality Class III & IV articles written by surgeons promoting the surgeries they sell. These 'studies'
are full of methodological flaws and outrageously sloppy reasoning which would be laughed at by anyone familiar with scientific
method and the accepted norms of medical research.
---- Many large dogs recover well without surgery, as do many dogs diagnosed with complete
ligament ruptures. These dogs' non-surgical recoveries disprove the claims that dogs-over-so-many-pounds always
require surgery or dogs-diagnosed-with-complete-ligament-tears always require surgery. The fact that vets make sweeping
statements like "Large dogs require surgery" in the absence of any solid evidence, and in spite of numerous successful
non-surgical recoveries by large dogs, shows that these vets are either incompetent or primarily interested in selling
high-profit surgical procedures.
---- It is true that large dogs and dogs with more severe ligament injuries are more likely
to require surgery than smaller dogs and dogs with less severe injuries. But the only way to know if a particular dog
really needs surgery is to restrict activity and see if the dog can re-stabilize the joint. Many large dogs & dogs
diagnosed with totally ruptured ligaments recover well without surgery.
---- A vet may have told you he was certain that your dog must have surgery.
But what is the foundation of that opinion? Could he be wrong? I have heard from thousands of people
who successfully helped their dogs recover without surgery from ligament injuries. A large proportion of these non-surgical
success stories begin "The vet told me my dog must have surgery."
Some vet-surgeons try to push people into agreeing to immediate surgery by telling them that
without immediate surgery their dog will be crippled with arthritis. This is not true. Controlling the
dog's activity during recovery is the key to minimizing future arthritic risk. Please see the page 'Arthritis Risk?'
here at this website for more detail on this. Link=Arthritis Risk?
Non-surgical recovery is based on careful activity restriction which provides the conditions
necessary for the dog's body to re-stabilize the joint without surgical intervention. Many dogs will recover well from
ligament injury without surgery if given the chance. More information on non-surgical recovery, and suggestions about
how to decide when surgery is appropriate, are on this website's page titled 'Diagnosis & Treatment'.
I get email daily from people who have succeeded in helping their dogs recover non-surgically
after having been told by vets that surgery was their only choice. For example:
-----Hi Max, I was told my dog needed TPLO surgery but decided to
try the non-surgical approach instead. I am extremely happy with the results. Thank you for your web site. My dog is
able to run, hunt, play, swim, in other words live a complete life and does not limp or favor his right rear leg. He appears
to be totally pain free. I am extremely pleased that I did not subject my friend to the pain, trauma, and uncertainty of major
surgery. Also, saving that kind of money does not hurt my feelings.
From one dog lover to another, thanks.
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In those cases where proper restriction of activity
does not result in improvement, surgery is appropriate. When surgery is needed, the type of surgery
you choose is important. The
'TPLO/TTA' page here at this website explains further why you should be skeptical
of a recommendation for TPLO or TTA.
Link=TPLO --Very Seldom A Good Choice
Email Question: "I have been going to the same vet for years and I trust him. He says TPLO is the 'Gold Standard'
in treatment. Why shouldn't I depend on his judgment?"
---- There are honest, well-intentioned
general practice vets who mistakenly believe that the TPLO & TTA procedures are a good first-choice treatment for the
majority of dogs with ligament injuries. Why is this so? Why do many general practice vets have a good opinion of these very
invasive surgeries?
---- First, the huge profit in TPLO
and TTA has influenced numbers of ortho-specialists to prefer these procedures. These specialists have a great deal
of influence with general practice vets like your regular vet. When your general practice vet hears from specialists
that they prefer the TPLO, he may not ask himself if the thousands of dollars of profit in each TPLO could be the reason the
specialists think so highly of the procedure.
--- Also, it is true that improvement
in leg use in the first few weeks after TPLO or TTA will be better than with non-surgical treatment or conventional surgery.
Longer-term results are not superior with these very invasive procedures, and the risks of serious complications are
much greater, but this rapid improvement in the short-term influences vets' opinions of the procedures.
"...Medical history is littered with once-popular procedures that subsequently proved
ineffective or dangerous. ..."
----A quote from Consumer Reports
'On Health'
Tricking Ourselves Into Choosing The Expensive Option Rather Than The Best Option.
When our dogs are injured, we are not concerned about cost. We want what's best for our dogs,
regardless of cost. It is easy to trick ourselves into thinking that because a surgery is more expensive it must be better.
A better car costs more; better shoes cost more. The best of anything is usually more costly. When faced with choices where
we are unfamiliar with the options available but want the best, we may assume (or be easily convinced) that the more expensive
options are the best options. But with dogs' ligament injuries, the more expensive options can be the poorer choices. Surgery
is often not the best option for the dog. The more expensive surgeries can be the worst choices of all.
Exaggerated claims by surgeons about the results
that should be expected from the surgeries they sell---
Have you been told that the surgery being recommended
for your dog will return Fido to pre-injury condition? An
article on canine ligament injury surgeries in the 'Journal of the American Veterinary Medical Association' looked
into what results could be expected from the various ligament surgeries in terms of percentages of dogs who regained normal
leg function after surgery. There is a quotation from this article here at this website on the page 'Surgical Recommendation?'
_________________________________
"...There are no studies that I know of
that compare surgery success to doing nothing over the lifetime of dogs who have one or the other experience. I think that
these studies don't exist because they never looked very good for the surgery and so surgeons weren't too interested in doing
them..." -
---Highly respected author & vet Mike Richards
I don't like Dr Richards referring to non-surgical recoveries
as "doing nothing" since this might imply to some readers that the dog can be allowed to decide his own activity during recovery.
But I agree with his implied conclusion. Surgeons are in the business of selling surgery. Don't
think they are saints. Don't think any doctor is any less interested in making money than anyone else who sells a service.
Be as skeptical of their statements as you would be in any other situation where you were being asked to purchase a service.
_________________________________________
I hope you will find the information here at this website useful in making the best decision
for your dog. I welcome questions and comments. My name is Max. My email address is on the 'Contact Info'
page.
