Laurie's Blogs.

Recently, I had two patients / cases that reminded me of the important role that we play in CLIENT SUPPORT.  Last week, I talked about the client that needed hope, a plan, and a hug. (https://www.fourleg.com/Blog?b=568)  This week it’s a client that needed someone to be objective and talk them through their options.

 Note... this isn't the radiograph of the dog in question...

Case 2:

This case is that of an 11 month old male Golden Retriever who suddenly became lame.  They had tried rest, but he lives with another Golden in the household, and it’s not easy to keep them from wresting together!  The owners stated that the rest didn’t help, so they sought out the veterinarian for an evaluation

On veterinary evaluation, the soreness was isolated to the elbow.  Radiographs were taken of both elbows, and a referral was sent to the specialist centre.

At the specialist centre, the dog was taken from the owners and an evaluation was performed.  The synopsis was “Elbow Dysplasia” and the dog needed a CT scan followed by surgery, which could be done on the same day.  The owners asked if they could be shown on the x-rays the area that was problematic.  The surgeon then admitted that he hadn’t looked at the x-rays that the referring veterinarian had sent.  

When looking at the radiographs the surgeon took some time, then circled a spot saying, that was the issue.  The owners left, feeling a bit out of sorts that they had been advised to do surgery when the surgeon hadn’t looked at the x-rays.  They did not commit to a CT or surgery date at that time.

Here in come the breeders.  They are lovely, long-time clients of mine… and like many breeders, full of advice, thoughts, instructions, criticism, etc.  So, I was sent a video of the dog, and the x-rays to look at.  Well, I’m no radiologist, but I couldn’t see a big difference between the left and the right elbow.  I asked if the x-rays had been read by a radiologist.  No, they hadn’t.  So, the breeders figured that the best way to get an objective assessment was to send them to OFA to be read.  They came back as grade 1 Elbow Dysplasia with mild degenerative joint disease bilaterally.

Now, this dog is very lame.  So, the breeders asked if I would see the dog to weigh in with my thoughts.  I agreed.  I too localized the discomfort to the elbow.  But… the dog had full ROM, no pain to palpate the side of the anconeal process, and no pain on my compression tests.  He was painful to poke in at the anterior elbow crease and with the ‘forearm rotation test’.  

So, here in lies the dilemma.  Yes, this appears to be elbow.  The radiographs don’t match the degree of lameness.  Maybe the issue is a fissure of the coronoid process (which doesn’t show on x-ray)… but at this point, nobody can say what the problem actually is!  And to top it off, the owners were very ‘put off’ by the surgeon they saw and his quick recommendation to do surgery without looking at any images.  So, the owners don’t want to go back to see him.

Where does this leave them?  Well, the breeders were thinking that another consult would be in order.  I stated, that would just give them 5 opinions (3 vets, a physio, and 2 breeders).  That’s not going to help them to decide.  So, I suggested to follow up with the CT-scan.  That would make sense.  Then, with that information, they could choose to stay at the same surgical centre, or go elsewhere if they didn’t feel that the surgeon that they first saw had made them feel comfortable enough to proceed with him as the surgeon for their dog!

And, just to throw this out there as well… if it’s a ‘fissure’ of the coronoid process.  THAT might heal with time, some modalities to stimulate bone healing, and ‘bubble wrap’ to keep the dog from bashing and crashing.  

So where are we now?  Waiting for the CT report.

What’s the moral of the story?  Sometimes our job is to be the objective person (with nothing to gain) that either supports the recommendation, or provides some options that the owner might feel more comfortable with.  It must be acknowledged that the owner is a very important part of the equation!

So, food for thought, and this week, I will also challenge you to critically assess whether you are providing the support that your animal owners want and desperately need.  Are you analyzing the situation?  Are you providing enough education?  Are you reading their body language?  Are you asking enough questions?  Give it some thought!  I’d love to hear your comments!

On that note, have a great week!

Cheers,  Laurie