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Advice on options for [possible] CHD in pup?

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OK, this is really overwhelming...why is he limping if he's been restricted? Have they done a check on his ACL yet? Just tossing out ideas but it does seem *real* odd that he has 3 of 4 major joints with issues.

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By "restricted activities", I've been following the vet's rules. When he first had surgery for OCD, it was outside (on a leash) for elimination only (for two weeks). He didn't have to be crated inside but had to be restrained to a small room with a nonslippery floor where he couldn't climb on furniture. In fact she felt it was best not to crate him any more than I had to - his muscles will stiffen and atrophy. And no access to stairs.

 

After two weeks we added walks, twice per day, starting at five minutes per walk. After half a week we increased the duration of each walk by five minutes. We also did physical therapy exercises twice per day (~ 1 hour per session).

 

By the time he hurt his hind leg, he had worked his way up to two ~ 1-hour walks per day. When he went lame in his rear leg, she had us back him down to 10-15 minute walks. We were supposed to periodically increase them, but not to the point where he wouldn't put any weight on the leg for the rest of the day (we should expect that he might not put any weight on the leg for a few steps after getting up from a nap - that didn't count as a sign of overdoing it). She was adamant that exercise was really important for him to continue. So, it's really only "restricted" in that he can't play with other dogs, do stairs, or "fetch". (He can play "catch" from his down stay).

 

So, he's gone from (at first) not putting any weight at all on the right rear leg (when he first hurt it a month ago), to now putting weight on it, except when he first gets up. But he's still offloading weight to his other limbs, and it's clear in his gait and in his stance. This is what doesn't seem to be getting any better.

 

I've upped his walks (with her consent) to ~ 40 minutes twice a day. I don't see the signs she warned me of that would indicate that he's overdoing it.

 

Maybe it's the hip. Maybe it's not. It seemed like it was the most likely cause. I guess we'll know for sure this Wednesday.

 

I'm with you. It seems awfully weird to have such major problems with three different limbs. As I said in an earlier post, we were careful not to overdo things with him, and I quizzed the regular vet pretty thoroughly about things he should, and shouldn't, be allowed to do, when we first got him. I do kind of feel as if we've been hit by lightning. "Shellshocked" is the phrase, I guess. Pretty depressing.

 

His shoulders have done swimmingly well ever since his surgery. If the walks we were doing were too much (even though we religiously followed her dictates), I'd have thought that they'd have been the weak link, and would have been reinjured. She feels that part of the reason why his hip dysplasia may have become symptomatic is because he was offloading weight from his front legs (after surgery) to his hind ones. Maybe that's the explanation.

 

By the way: many thanks for the suggestion for working with two leads. We did put him on a prong collar, and worked our way up from "gentlest possible" setting to something a bit more authoritative when he pulled at the gentle setting. I'm able to control him most of the time with his buckle collar. I tell people (when they ask) that the other one is his "emergency brake". I hardly ever need to use it, and I'm careful about using it around other dogs because I don't want to set up negative associations.

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Your welcome! Emergency Brakes - Power Steering, it works and that's what matters right now!

 

Good luck tomorrow. I know you will let us know what's happening!

 

Lots of good mojo for you and Duncan!

 

smiley-happy110.gif

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Thanks for the good wishes!

 

We're leaving directly from the vet's to collect my nephew - then the five of us (humans: DH, our two sons, our nephew) + pup (of course!) are all driving up to Brooklyn for Thanksgiving (along with the rest of the world on the NJ Turnpike). So it may be late before we're able to fill anyone in. Plus I've promised to bake three pies when I get there.

 

If they recommend surgery, we're definitely seeking a second opinion. Hate to race into things this serious on a young pup without being sure of what we're doing. Have heard of too many missed diagnoses to want to proceed otherwise. And I'm planning on asking a zillion questions about "have they ruled out X"; "what about Y therapy"; and so forth.

 

I feel very fortunate to have benefitted from all the advice I've gleaned from y'all on the BC Boards!

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It's bad news, I'm afraid. Duncan has bilateral hip dysplasia. It's worse on the right side (explaining why he's limping), but it's popping in and out on the left side as well.

 

We had them run a full gamut of X-rays on his hind end - both hips, spine, and on the right side, his knee and ankle. The vet is certain it's the hip dysplasia that's responsible for his lameness.

 

We're probably going to work on a "maintenance" plan at present. She recommends monthly physical therapy (and she showed us exercises we can do at home). She did feel that the physical therapy she's done on him every week during the last month was the sort of thing that got 70-80% of (young) dogs to the point where they didn't need surgery; that he hasn't responded to it doesn't bode well (in her opinion) as far as being able to avoid surgery in his future.

 

Poor pup. He's busy charming all my in-laws at present. They can't believe how sweet and how well-behaved he is. They knew my last Border collie, but Duncan is in a class of his own.

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Well crap. I'm so sorry it's not the news you were hoping for - Duncan sure can be thankful for his amazing family this holiday season. ((hugs))

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Sorry to miss this question. (Things got pretty crazy for us between Thanksgiving and Xmas).

 

No easy answers as far as food goes, I'm afraid. As with most things in life, I researched the question of "food" pretty thoroughly. On the advice of his regular vet, and with all due respect to those who feed "raw", we switched him over to adult kibble (of the relatively low protein variety) at 4 months of age. After many hours of research (here on the BC Boards as well as sites such as http://www.dogfoodanalysis.com/ ), we opted to feed him Innova "Large Bites" (not Innova EVO), supplemented by a couple of spoonsful of canned pumpkin, along with Derm Caps for his coat. This food had the top rating of all the kibbles of the "not high protein variety" we could buy locally; it also didn't contain preservatives such as ethoxyquin that some believe can trigger epilepsy (a disease my last Border collie endured), and seemed to have good ingredients throughout. Although it contains grain (pretty much by definition if it's not high in protein), it's of the non-allergenic variety (barley, brown rice, rice) rather than corn. We don't free-feed; anything he doesn't eat right away gets picked up and tossed out. We also paid careful attention to his weight to make sure that he was always on the light side (i.e., that we could feel his ribs and spine easily, though not to the point of emaciation).

 

That being said, he is on the large side as far as Border collies go (close to 50 lb at 10 months, though he was around 40 lb by 6 months). It's possible that his larger size may have predisposed him to joint injuries, but I honestly don't think that his joint problems were caused by overnutrition.

 

When we first went in for our consult with the ortho vet, he asked what we were feeding him and how. He told us that Innova was an excellent food and that it sounded as if we'd done all the right things. Also said his weight looked perfect.

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I'd like to thank all those who have offered advice and support. It's been a month of ups and downs, but your help has certainly been invaluable during the tougher moments.

 

On the up side, Duncan went back to the ortho rehab vet last Tuesday for the first time since the diagnosis of CHD. She was more optimistic (though still cautiously so) than she's been for some time. Yes, he was still offloading some weight from his rear right leg. But he seemed much less "ouchy" on physical manipulation than he has been in the past. She definitely would not rush into surgery. Wait and see if he continues to improve under the current regimen.

 

That regimen being: monthly physical therapy at the ortho vet's (laser therapy; magnetic field therapy; massage therapy). One tablet of Dasuquin each day, and half a tablet of Rimadyl in the morning. She feels that the best thing for him would be to build up muscle mass in his hindquarters. The best way to achieve that is to give him as much exercise as he'll tolerate - short of its hurting him, which means he'll start to limp, which would be counterproductive. She recommends leash walking. Limit off-leash play, and avoid activities (like playing with other dogs or romping in our hilly, wooded back yard) that will overtax him. We had allowed him to overdo it the previous Saturday (it's not often we get nearly two feet of snow, and he had the time of his life bounding through it; unfortunately he limped for the rest of the day). The good thing, though, she said, was that he'd bounced back from this and his limp was barely perceptible a few days later. Let him do it again if we have another snowfall, but for a shorter duration. So, continue the process of "calibration" and watch his responses to see when he's had enough. We also do "range of motion" exercises on his hind limbs following a walk. When weather (and holiday craziness!) permit, I take him on a walk twice a day, for a mile or two each time, and he seems to tolerate that well - no increased lameness afterwards. But I have to be careful on icy sidewalks, so we've had to cut out nighttime walks; neither he nor I needs to injure ourselves in that manner (and I've fallen hard twice on the ice as it is this winter).

 

She asked whether we were giving him any fish oil supplements; she said there was evidence that this could aid in healing. We told her he was getting Derm Caps and she said these were good (though she prefers the Wellness products).

 

They have an underwater treadmill, which provides for more normal movement than swimming, but their rule is "no lame dogs in the water". So he's not doing any swimming. (The one time we tried him on it, back in August before his OCD surgery, he hated it, so he certainly doesn't object to any absence of swimming in his life).

 

We asked about Transcutaneous Electrical Neuromuscular Stimulation (TENS), as someone had mentioned it. She said that she was nervous about using it on a pup whose growth plates hadn't closed. We also asked about stem cell therapy, as that had been suggested by several. She said that their practice has used it very successfully for certain things, such as shoulder injuries. It could definitely promote healing. She also said that while she occasionally had seen it work well for situations that she hadn't felt would respond to it, she would not recommend it in this case. The underlying problem is not so much one of injury as it is of an anatomically incorrect joint, and she doesn't feel that stem cell therapy would address that. She said it's very expensive ($3,000), and for the money, she'd go with surgery, which she felt was more certain to provide the desired results - if he gets to the point where the current regimen isn't cutting it. We also asked about shock wave therapy. She said that was useful for some things, like calcified tendons, but it seemed as their experience had found that it didn't always hold up the initial promise provided by some of the early reports. It's not easy on an animal, as you need to sedate them for the therapy.

 

We debated Dasuquin vs Adequan. (He had been on Adequan shortly after OCD surgery). Their practice is to use Dasuquin after an initial month of Adequan, but when pressed, she said that it couldn't hurt if we continued to administer Adequan, and agreed to approve my online order. (That saves us a pretty penny; they charge $40-odd per shot, not including the two hours of driving to get there and back, while if we give it ourselves, it's only $10-odd per shot). My DH has gotten good at IM injections, and he's learned to approach Duncan with a "blank" syringe and a treat so that Duncan won't flinch away when he sees one coming. She's recommending a regimen of once a week for a month, to be followed by monthly injections.

 

We also opted to have him start acupuncture treatments. Fortunately I don't have to drive as far for this as I do to get to the ortho vet. Duncan has now had three acupuncture treatments at weekly intervals. After a month, we'll drop to biweekly, then monthly intervals. While it's hard to get a reliable answer when you ask a dog whether it's helped, I have seen more of a spring to his step after treatments. The hope is that this will alleviate the pain, allowing him to use his leg more (and build up muscle mass).

 

One of the reasons why we're anxious to avoid surgery at the moment (apart from the cost, and apart from the question of whether it's necessary) is that it turns out that my DH needs heart surgery (a new heart valve) sooner rather than later - probably during January. So that's one of the major "downs" in our lives. (This was discovered a week ago when he was trying to get medical clearance for arthroscopic surgery on his knee. Said clearance being denied, I guess I'm going to continue as chief dog-walker for the next few months).

 

Back on the "up" side, older son is now a licensed driver, and can transport himself and his younger brother to school in the car that DH won't be using. And said older son heard in mid-December that he was admitted to his first choice college (via early decision). This means that we save a tidy sum on those college applications that no longer need to be submitted Jan. 1. It also means that we save on travel costs that would have been incurred in his revisiting colleges trying to decide which to attend, because the decision has now been made. That will help in paying the vet and acupuncture bills! (Tuition? that's next year's concern).

 

OK, time to take the pup for that promised walk in the park!

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Wow! You've really been through it! Hope Duncan continues to improve, or at least, get no worse. Scooter has "mild hip dysplasia" and I notice now with the colder weather here in Ohio, he's having more episodes of spasms and pain. He's limping again today, so he's on "room rest"--the small office with the recliner and the t.v., blocked off with a baby gate, so he's not running up and down the stairs trying to follow us around the house. It hurts to see them less than 100%. :D

 

Good luck with your husband's surgery. Shortly after we got Scooter, DH had emergency abdominal aortic aneurysm surgery and I was at the hospital much of the time, forcing me to leave a young pup alone for hours unless we could find a neighbor kind enough to come in and let him out and play with him. Once he got home, he had a pretty long recovery period so I was trainer, pooper scooper, walker, etc. But pups and husbands can be pretty resilient. :rolleyes:

 

Thoughts and prayers being sent your way for Duncan, DH and you.

 

Pam

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I'm curious as to why your vet is trying so hard to avoid surgery. This is not in any way meant to be a criticism, so please don't take it that way. But, it seems to me that you all are spending an awful lot of money on treatments and medicines and physical therapy, etc., when surgery could put an end to all of that and let your pup get on the road to recovery and a relatively normal, pain free, and active life. I certainly understand your hesitation because of financial reasons, but you are/have been dumping a lot of money into your dog without getting much in return (he's still experiencing lameness and loss of muscle mass). When I am talking about surgery, I'm talking about FHO, not total hip replacement. Total hip replacement is cost-prohibitive for most and it's success rate is not always great, though I understand that it is more successful with younger dogs. But, FHO is relatively cheap, as far as surgeries go. And you could do one hip at a time, so you'd be spreading the cost out over several months.

 

I just find it odd that your vet is trying so hard to avoid the surgery, especially considering that your very young dog is already symptomatic and is probably going to continue to be symptomatic.

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I'm curious as to why your vet is trying so hard to avoid surgery.

 

The ortho rehab vet has told us that in 70-80% of young dogs she treats, the current regimen will get them "off the surgery list", meaning they're no longer symptomatic. At that point we might be able to gradually reintroduce some of his favorite activities, proceeding exceedingly cautiously. Hopefully that will include some of the things that make for "quality of life" for him. She'd rather not do anything as drastic as FHO or THR if exercise alone will restore "quality of life". She didn't measure his muscle mass at the last visit, but the diminished tenderness made her optimistic. We both agree that waiting to see how things go is worth a try - it's not just my reluctance to jump into this, it's that he may be improving without surgery.

 

Apart from finances, it's also a matter of how much responsibility I can take on at once. DH will likely be out of commission for two months following his impending open heart surgery. I managed to make sure Duncan's physical therapy happened for 3 months following the OCD surgery (though two hours a day of physical therapy, on top of two hours per day of leash walks and half a day each week off work to take him to the ortho vet was tough on top of a full-time job), but I wasn't also coping with helping DH through his own rehab. DH does more than his fair share of running the household (including the grocery shopping, all the laundry, kid lunch-making, all the bill-paying, and more than half of the cooking). Picking up the slack that will result from his being out of commission, while still juggling my job, is going to be a challenge.

 

It's my understanding that physical therapy following FHO surgery is critical to a good outcome. I just don't think I can take that on at this point in my life - DH's health has to come first. Post-surgical PT is just not something I can ask my kindly neighbors to help with, great as they are. If Duncan's current regimen doesn't do the job, then I'll certainly revisit the question of surgery in a few months. Hopefully our lives will have settled down a bit by that point. With even more luck, the question of surgery will be moot.

 

But certainly if anyone has had any experience with either FHO surgery or with total hip replacement, I'd love to hear how it went. My understanding is that FHO surgery, while less expensive, is less likely to have a successful outcome for larger or more active dogs (Duncan weighs 50 lb, and he's still got some growing to do). PT after surgery is critical to its success. The success of total hip replacements seems to be contingent on keeping the dog immobilized after surgery. With either of these, if something goes wrong... there's little that can be done; the dog could end up in worse pain, for life, than he seems to be suffering at the moment. (His limp, most days, is only perceptible to the educated eye).

 

Thoughts and prayers being sent your way for Duncan, DH and you.

 

Thanks, Pam! That really helps. DH is reasonably healthy (though, at 53, he is the last living male of his generation in his family - sobering thought). I can't wait to have my dog-walking (etc., etc.!) partner back "in the pink", much as I'm apprehensive about his surgery.

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But certainly if anyone has had any experience with either FHO surgery or with total hip replacement, I'd love to hear how it went. My understanding is that FHO surgery, while less expensive, is less likely to have a successful outcome for larger or more active dogs (Duncan weighs 50 lb, and he's still got some growing to do). PT after surgery is critical to its success.

 

Yes, 50 lbs is about at the limit for FHO. We did double FHO on one of our foster dogs about a year ago (first surgery was in January and second surgery was in April). He was probably around 48 lbs. He had a lot of muscle mass in his chest and upper body and very little muscle mass in his hind quarters. He was about 3 years old. He did really well with the surgeries. He was putting weight on his leg within a week of each surgery and was running within a month. We didn't do much in the way of PT other than letting him be as active as he wanted (per our vet's advice), which was pretty easy because this dog loved to be active and loved to chase any toy you were willing to throw. We also took him swimming in the ocean and running on the beach. He never did want to swim in the pool, but he was more than happy to swim in the ocean. We gave him pain meds for a few days after each surgery, but that was it. Here is a video of him shortly before he was adopted, which was about 4 months after his second surgery. You can see just how active and nearly normal he is.

 

th_MVI_0647.jpg

 

I'm certainly not trying to talk you into anything and I definitely understand the financial strain and the other responsibilities that you have to deal with right now. I just hate to see you throwing so much money and time into trying to keep your dog off the surgery list, when surgery could just put an end to all of that. But, obviously, you have to do what you believe is right for you and your situation. I wish you and your pup (and your husband) luck!

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It's my understanding that physical therapy following FHO surgery is critical to a good outcome. I just don't think I can take that on at this point in my life - DH's health has to come first. Post-surgical PT is just not something I can ask my kindly neighbors to help with, great as they are. If Duncan's current regimen doesn't do the job, then I'll certainly revisit the question of surgery in a few months. Hopefully our lives will have settled down a bit by that point. With even more luck, the question of surgery will be moot.

 

But certainly if anyone has had any experience with either FHO surgery or with total hip replacement, I'd love to hear how it went. My understanding is that FHO surgery, while less expensive, is less likely to have a successful outcome for larger or more active dogs (Duncan weighs 50 lb, and he's still got some growing to do). PT after surgery is critical to its success.

 

Back in the early 90's my aunt had a lab mix that had FHO surgery after her hip had popped out of socket due to an accident and wasn't detected until a few weeks afterward. The surgery was performed by a local vet and other than keeping Molly (the dog) a bit quieter while she recovered from surgery, they did little in the way of PT. She weighed between 50#-60# her entire adult life and the only difference after she had heeled up from surgery is she didn't quite hit the 4' vertical leaps like she had previously. Other than that she led an active, pain free life for the next 10 years.

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The general advice on FHO rehab in this area - both by regular vets and the 2 ortho guys - is what MaryP said. Basically they let the dog be a dog. There is no elaborate rehab or pt.

 

I don't understand you current advice against swimming the pup. Coming from both the position of a person who's worked with HD and OCD dogs, and human medicine we vitually never restrict swimming. Lack of muscle mass is the kiss of death for arthritic issues, and swimming is encouraged from the moment the surgical incision and restriction is up.

 

And then there is the issue that a few more pounds and the FHO is out. The time appears to be now.

 

Internet is a poor vet though, so I encourage you to get a second opinion from a professional.

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Thanks, Mary and Maralynn, for sharing these experiences. It's reassuring to hear (and see!) that dogs can do well without much in the way of physical therapy.

 

Lenajo: is it the "weight at surgery" that's the deciding point for FHO, or the "adult weight"? I'd assumed it was the latter as that's what dictates the strain placed on the false joint. But you're right, the internet is no substitute for a second opinion.

 

On the swimming: I'm not sure why the ortho vet has this "no lame dogs in the water" policy. Definitely something to bring up when we seek a second opinion.

 

Here are the OFA guidelines (from http://www.offa.org/hiptreat.html ). With the exception of the difference in opinion between our ortho rehab vet and OFA on swimming, the regimen prescribed by the ortho rehab vet closely follows OFA's "management" protocol at present:

 

"Once osteoarthritis is present on a radiograph, dysplastic changes are irreversible and usually continue to progress over time. If a dysplastic dog has secondary arthritis and pain, most owners elect to first treat their dog with medical management. The key to medical management of arthritis is weight control and exercise management. Studies have shown that up to 76% of severely dysplastic dogs with arthritis secondary to HD are able to function and live comfortable quality lives with conservative management.

With weight control, the goal is to prevent the dog from becoming overweight to reduce mechanical stresses applied to the hip joints. In general terms, the ribs should be easily palpated and there should be an indentation in front of the pelvic wings (waist line).

 

Controlled exercise is indicated to prevent or relieve the inflammatory process that leads to the pain associated with arthritis. The amount and difficulty of the activity is determined on a trial and error basis. Exercise should start with short leash walks and be gradually increased until the dog reaches the desired level of activity. If clinical signs start to reappear, the amount of exercise is scaled back to a level that will not cause clinical signs. Overall, exercise should fit to an individual dog's maximum intensity level with the goal to maintain muscle tone and cardiovascular function without causing pain, stiffness, and inflammation to the joint. The right amount of exercise helps to maintain muscle tone and strength and stabilizes the unstable dysplastic joint. Exercise also improves joint range of motion which in turn, keeps the dog more comfortable. Swimming, because it is a non-weight bearing exercise, can be a very useful means of maintaining muscle tone and range of motion without placing concussive forces on the joint."

 

As far as surgical options and the need for postop physical therapy, OFA's guidelines are again in line with what I'm being told by the ortho vet (emphasis added by me):

 

In younger dogs usually less than 10 months old with only subluxation caused by dysplasia, a triple pelvic osteotomy (TPO) can be performed to reestablish joint stability and encourage normal joint development and minimize abnormal biomechanical forces on the joint before osteoarthritis occurs. This procedure is not indicated if osteoarthitis is already present. Recovery time is about 6 weeks and a good success rate has been reported with return of normal hip function.

 

For older dogs (over 10 months) that already have established osteoarthritis and can no longer be medically managed, a total hip replacement is the treatment of choice for reestablishing normal, pain-free limb function and joint mechanics. A high degree of success has been reported with this surgery and like the TPO, post-op recovery is about 4-6 weeks. The main disadvantage to this surgery is the high cost.

 

An alternative surgery which is more of a salvage procedure when there is significant osteoarthritis and a total hip is cost prohibitive is a femoral head and neck excision. This eliminates hip pain by removing the femoral head and neck and initiating the development of a fibrous false joint that permits ambulation. The false joint is less stable with a reduced range of motion than the normal joint which in turn, causes an abnormal gait. Nevertheless, pain relief with adequate function can be achieved. The procedure can be performed in all dogs of all sizes, but there are usually better long-term success rates in smaller dogs less than 20 kg (about 44 pounds). Preoperative muscle mass and early postoperative physical therapy are two important factors in determining a successful outcome. This surgery is usually not as successful if there is severe disuse muscle wasting (atrophy) present and/or the animal is obese.

 

Heavier dogs usually require more extensive postoperative rehabilitation to help promote an ambulatory pain-free false joint. Rehabilitation is aimed at preserving and promoting the leg's muscle mass, strength and range of motion through early (3-5 days) postoperative weight bearing ambulation and passive range-of-motion exercises. Early ambulation can be achieved by assisting the dog in getting up and walking. A towel can be placed under the abdomen to make assistance easier to perform in heavy dogs. Leash walks and/or swimming beginning the day of discharge from the hospital should be performed until near normal use of the leg returns. Passive range of motion physical therapy is also necessary to increase muscle strength and flexibility. Dogs that are obese, inactive or have substantial muscle atrophy and have poor owner compliance with physical therapy recommendations are poor candidates for this surgery.

 

The emphasis on postop physical therapy (the ortho vet made it sound like weeks of such); the fact that Duncan is already above the stated weight limit for FHO and (at least last November) already had some muscle atrophy; and the high cost ($5K) of total hip replacement all made me leery of leaping into surgery while DH is, himself, on the surgical list.

 

All in all, it sounds to me (from all I'm hearing from y'all) as if it's time for a second opinion. If nothing else, not having to drive so far to the ortho vet would make my life a heckuva lot easier right now. I thank you all for your advice!

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