Surviving Veterinary Medicine. Be smart, be bold, be creative and be your own boss. At the very least, find a practice where you can do what you do in the most positive way that gives you the space to practice medicine as you see fit. Because at SVM we set a higher standard for medicine than what you learned in school.
Dr. Robinson: Well, welcome to Wait! Don’t Cut! And I am Dr. Narda Robinson, founder and CEO of CuraCore VET and CuraCore MED. I am an osteopathic physician and a veterinarian.
And I want to talk to you today about the kind of the client dialogue that we can have as veterinarians about whether or not to pursue surgery or just at least to empower them in terms of when they have an animal that might have spinal cord injury or cruciate issues or anything else, that there are principles that we can instill in them and information that we can provide that helps them make the information with you as their clinician, doctor, veterinarian, so that they don’t just, if they are going to go for a referral, that they aren’t just feeling helpless when they go.
My goal for you is to be empowered. That is to reduce your fear of questioning surgeon’s recommendations. So, we want to raise your awareness about non-surgical options. Part of that is you can tune in to any of my webinars on YouTube on CuraCore VET YouTube channel.
But another way is, as I have here, you can go online, go to pubmed.gov and put in search terms. Even if you said “TPLO” (which is of course going to be dog) and you said “Risks,” so that you can find literature that talks about this.
Now some of these will be free, full-text, so open online access on the left side of that screen that you’ll draw up with pubmed.gov, you can just select articles that will have free, full-text and then you can read that. And if you don’t understand it all, you could maybe talk to your vet and see what the literature actually says.
Because there is inadequate information to defend what I have seen as the surgeon’s very adamant recommendations that you need spinal surgery or you need knee stifle surgery when things go wrong.
So, when is surgery necessary and which surgeons will tell you? Big, big question. And it is not set in stone and in veterinary medicine, we don’t have enough evidence to give a solid answer. Even in human medicine, as you’ll see, there is lots of room for debate.
Looking at the human field and the uneven terrain of even orthopedic surgery. This is a 2017 article, not the last word;
“Unnecessary surgery can never be done well.”
And they’re talking about, for example, knee replacements.
“So, knee replacements in patients under the age of 55 with only mild osteoarthritis on radiographs is an operation that is evidently performed with some frequency.”
Meaning too many times. And as they go on,
“Because unnecessary surgery…”
implying that all these other surgeries for the 55-year-olds with really hardly any evidence of osteoarthritis.
“Because this unnecessary surgery can never be done well, the focus of research must shift from examining how to perform surgery, to examining who should really undergo surgery.”
So, you can see, even though human medicine is so often more well researched, advanced, debated, all these things, that it is far from a settled question about who should get surgery and when.
And then as a commentary to this letter or piece, this other individual who is an orthopedic surgeon and vice chairman of orthopedics at Montefiore Medical Center said,
“The literature describes an epidemic of overdiagnosis and overtreatment. And the treatment of individuals with low back pain, for example, is a poster child for excessive care.”
So, here brings in this piece about spinal cord, spinal injury, disc disease, back pain, neck pain in our small animals. Again, because it’s not even settled, and why isn’t it for humans? Who is calling the shots? This is always the recurring question. Who is setting the gold standard? Who is setting standard of care?
And really, there is no one set standard; you can think of the United States and North America in general, Canada. So, it matters what the people around you in your community are doing. That is more what decides standard of care.
So, that even brings up questions like, well, what’s the best? Is this just because this is a population, people get a vote on it? You’ve got a big surgery center and so it’s going to be surgery heavy, the standard of care. Shouldn’t this be based on the evidence and best practices?
Anyway, Levine continues;
“Maybe it is time that we critically analyze how we are caring for the public and identify better strategies. Despite spending more per capita than any other kind of well-developed country, our quality of care pales in comparison to almost all of these countries.”
So, what is driving this?
“I suggest that we redirect our efforts and focus on the welfare of patients and the primacy of patient care. This philosophical change of advocating for our patients will ultimately be better for our patients and our professional satisfaction.”
As you dig into even how human physicians, human surgeons are feeling about what’s going on and what forces are driving all this excess surgery, then we can think of, well, how does that filter down? What does that reflecting on with veterinary medicine and who’s pushing back and why?
“To maintain efficiency, we perform a physician-centric encounter.”
Is that what you do? And for the vets here, is that what you are doing in your veterinary practice? Is this all about the practitioners, the veterinarians and the business or the teaching hospital or whatever? I know I’ve been in situations where that was very much what it was. It was all about the business. It wasn’t patient centered.
So here they go on;
“Brief evaluations with rapid recommendations on imaging and therapy.”
I think of orthopedic surgery centers for humans that I’ve been to. And it is quite assembly line. You go in, check in, go to the doctor; very brief. Let’s go to imaging. Let’s go to therapy, especially when that center owns their MRI machine and their physical therapy.”
There used to be bigger restrictions on that, I believe, in terms of conflicts of interest. But who are we to say? We’re veterinarians. Because we sell food, we sell the drugs, we have it all as well, which has pros, but it also has considerations.
“We spend less time enjoying our visits (Does that sound familiar?), less time teaching our patients and we want to avoid adversarial encounters by complying with requests for imaging. ‘Hey, doc, I want an X-ray. I want an MRI.’ Therapy; ‘You’ve got to send me to physical therapy and pain medication. I’d like 30 OxyContin with two refills, please.’”
So, there’s so many forces; the pharmaceutical industry, the insurance companies, various other private pay entities, Medicare, so many things.
“In the patient-centric encounter, we enjoy meeting our patients. The patient has sufficient time to explain his or her problem, and we spend the necessary time to examine our patient and adequately discuss treatment strategies.”
So, I mean, I’m so old that I remember when people had their own practices. I’ve had my own practices. And you set your own guidelines. But apparently, that has changed.
So, again, when we flip to veterinary medicine, we’re going to think about intervertebral disc disease and spinal cord injury and what is the go-to approach to that and considering what our veterinary school is teaching. And, yeah, are they teaching photomedicine and medical acupuncture and rehab as first line care? No.
For those of you that have been conditioned to expect that we’re going to have strict confinement, where is the evidence for that? There is none.
So, if you, instead of a situation where there is controlled activity, that makes sense. But there are wrong outcomes that happen with strict confinement anyway. But think about just the mental impact. And when your spinal cord is injured and there’s been neurologic miscommunication or dysfunction disconnection, then the rewiring and the communication channels that happen need to have appropriate movement and conditioning to make that rewiring circuitry fire in a useful, functional way.
Some people say nerves that fire together, wire together, which causes us to consider in the integrative scientific world about medical acupuncture and movement in rehab, just thinking, how do we make the body, how do we encourage it to fire in a healthful way? Rather than how we see from these long periods of strict confinement, animals losing their ability to be coordinated, they lose their strength. If they’re not weight bearing appropriately, their joints degenerate because it is weight bearing that causes the good nourishment, the good nutritional supply, to the joint surfaces. So, it’s very important not to do that.
It’s important to control their activity as well. But we are currently in the midst of this paradigm shift where we have the old guard, who was so much more reflexive into surgery or high dose steroids and strict confinement, and that’s it. And don’t do anything else and those rehabbers will hurt you or acupuncture is waco and all these other things.
Whereas now we are informed and we know that acupuncture is neurophysiologic-based on neuro anatomic principles and connective tissue changes that allow fascial easing and allow better restoration of communication between cells, between sheets of fascia, between muscle groups and so on.
So, there’s so much more to do. There’s so much more with an integrative rehab approach than just doing modalities of thinking you’re a physical therapist, but by actually reasoning through and dealing with that sensory motor integration that we want to restore.
So, for clients, realize that part of why I’m doing this is that you are subject to receiving information based on who you happen to be near geographically, who you happen to call for an appointment, what they say to you, what their experiences were, where did they go to school?
Because even among neurosurgeons in veterinary medicine, the approaches are not standardized. You could go to Colorado State University and depending on what faculty member you encounter, at which stage of faculty development, at which decade you happened to go in there, I mean, just my experiences teaching at CSU for 20 years, it varied extremely widely from when I was a student to in 2016 when I had left to start teaching with human medicine.
But that CSU versus Davis versus Penn; why differences? So, if it was all based on evidence and rigorous standards and best practices, you wouldn’t see such wide variability. But it’s not. It’s very, very subjective.
So, anyway, what’s happening in human back surgery so that we can get some understanding of what our brothers and sisters, or my colleagues, whatever, seeing over there.
And so, the types of topics that I tend to cover can be slightly edgy and people just generally don’t talk about it, just what I’m doing today. So, I really get a kick out of seeing other people that will push back and speak their truths and counter prevailing mindsets, especially when there’s not necessarily the highest ideals in play.
So, you can find this too on YouTube called License to Harm: A Surgeon’s Whistleblower Exposé on Surgery and Medical Care. Really good video to watch. He’s an orthopedic spine surgeon for over 40 years, formerly taught at University of Miami Medical School.
And as they say in the video, one topic that is considered taboo, veterinarians probably relate, and is usually never discussed is the integrity of surgeons. So, taboo to discuss the integrity of surgeons. And how a patient decides who needs surgery or how a doctor decides who needs surgery. Who is in charge here?
So, they ask in this dialogue: why would a surgeon perform a procedure that wasn’t warranted? And so, Dr. Nordt responds;
“Most surgeons are employed or want to make enough money to justify economically sustainable income.”
So, for the veterinarians in the audience, is this something you have heard? Is this something you can resonate with? Why would a surgeon perform a procedure that wasn’t warranted? We’re talking about money immediately.
And he says;
“It is money driven at this point in time.”
Has surgery become a business? This is another YouTube. So, I’m just taking brief excerpts, because that one was over 20 minutes. This is about a five-minute video. He says;
“In the current medical culture, revenue and expensive surgeries are a priority for corporate providers, and patients just become revenue and a product.”
Does that sound familiar?
“As the diagnostic and wellness aspect is neglected, health care becomes a business and a medical assembly line.”
And I include this because here I am, an osteopathic physician since the 80s and a veterinarian since the 90s. And I am an advocate for scientific integrative medicine, obviously. But here we have an orthopedic surgeon who has taught University of Miami, who has been a spine surgeon for 40 years or more, and he is himself questioning his colleagues.
“Patients have the responsibility to question and query their caregivers. So do clients, and it can be scary.”
So, I just want you to have this context so that you can understand that you are not alone.
On the video, there are a couple of patients that talk about their experiences. And there’s one who didn’t want to have surgery. And he says;
“When I told the surgeon that I didn’t want the surgery, it wasn’t a nice situation, I got a feeling it just seemed like he was kind of mad that I didn’t want it.”
And how many of you veterinarians that are on here or vet students during your career, how have you noticed the mood, the tenor, the information, the attitude change on the part of the caregivers when somebody said, “No, I don’t want to do that.” And in my experience, too, being at the university, it’s like, “Well, what if they want to try acupuncture? What if they want to try rehab?” How much effort had they had to push against a surgeon, a resident, whoever it was, in order to get their animal’s needs met in the way they felt it was fit and it was effective?
So, anyway, he goes on;
“There seems to be a rush to judgment and a rush to operate.”
So, think of the big TPLO centers in your area that are just — I know that one time I had recalled — Did I call or the client called in my presence. Because I just wanted a second opinion on this dog that I thought had a cruciate issue. And I thought, “Okay, if you feel like it, go to this orthopedic surgery center down south in Colorado and see what they say.”
And he called up and the receptionist answered and she said, “So, when do you want to schedule your surgery?” And he’s like, “I just want an appointment.” And they’re already scheduling surgeries just when you call in for an appointment. And then usually when they go down, I mean, it’s not unexpected to have them say, “Start saving for the other one because the other one will blow, too.”
So, if there’s a way that we can nourish tissue health, which there are ways, and if we can change the weight bearing parameters, if we change the strength, if we change the sensorimotor tone that governs integrity and protects it, if we correct imbalances between the agonists and antagonists of the cruciate, if indeed that’s what it was, and if we do a better job of diagnosing and we find out where is this problem really. And we’re not going to spend an hour pushing that tibia back and forth to see is there a drawer or not, because there are so many other conditions that it can be.
So, if you want to know more about all that, that’s in my Tragic TPLO webinar that we did a few weeks ago.
“In some cases, doctors fail to diagnose correctly, (which I was just talking about) in a rush to operate. And that can lead to improper diagnosis.”
which I think is fairly rampant in both veterinary and human medicine. Because of the shortening or elimination of the physical exam, they’re not even knowing how to do a myofascial palpation. And the lack of considering a broad differential diagnosis list and just having tunnel vision. Because you have five minutes, it’s like, “Okay, cruciate. You have fleas or whatever. You have this or that.”
And people and their animals are falling through the cracks and they’re spending a lot of money on potentially injurious responses to a misdiagnosis.
So, to reform an opaque medical system, old school physicians (I would consider myself one) recommend transparency first. Patients get to the point where they lose hope and they lose control of their medical destiny.
And that’s another thing for you who are clients here. Don’t lose control over your advocacy for your animal. Don’t be bowled over so much that you are just acquiescing and you don’t feel it’s right. You have to feel it’s right inside. And just see another veterinarian. Get some other input. See an integrative medicine from a scientific perspective practitioner.
Because I know, when I’ve been in a position where I have surrendered to somebody else’s, it just doesn’t turn out well. Medical acupuncture, medical massage, photomedicine and botanical medicine, just some features that relate to these approaches, mechanisms of action integrate with conditions such as intervertebral disc disease and orthopedic surgery problems, such that we’re matching mechanistically.
So, mechanism to mechanism, what is the mechanism of injury? What is the pathophysiology and how can we repair that with these techniques and really nourish the body and really get the strength going? Rather than cutting, we’re helping to repair. We’re helping to protect.
And in something like intervertebral disc disease, that can mean the difference between life and death, spinal instability, especially when it’s like, “Oh, there’s a little bit of bulge here. Let’s go ahead and take that too. Let’s do a hemilaminectomy on the one above and below.” And you’re just destabilizing the spine from a bony perspective, a ligamentous perspective and muscle perspective, because you’re not getting that proprioceptive protection that you would if things were intact. So, there can be ways to address spinal cord injury.
So, I know a lot of veterinarians are like, “We’ll, how do I advise my patients?” And I say, “Just give clients the information they need on how acupuncture and related techniques and botanicals can help to work to improve spinal cord health and the recovery process.”
And so, with dogs and especially Dachshunds, there’s a risk of recurrence. So, even after surgery, the rate of recurrence of neurologic signs, inconsequent euthanasia in dogs near 50 percent. They just don’t want to go through it again. They don’t want to put their animal through it. And why was that? Was there problems urinating or defecating after surgery? Were they in a huge amount of pain?
So, this idea that surgery is the gold standard, when you really look at it, it’s like there are a lot of problems that happen with surgery. Euthanasia; was that preventable? What do humans want? What do dogs need? Before, it was with drugs and surgery, but now it’s going to neural regeneration and neuroprotection.
But we can think of the whole patient. So, there’s the spinal cord issue. Yes, but the whole body is affected. So, we have pain, locally. We have neuropathic pain. So, maybe getting a little too in-depth for the clients in here, but let’s just say there’s a lot of different types of pain when the nervous system has been injured and when a patient is not ambulatory or able to move around. A lot of inflammation. You can have internal organ problems. You can still have weakness or paralysis that needs some kind of attention.
So, even if you’re cutting out things in the back, how are you going to restore the function of those nerves? You might have a urinary and fecal incontinence. What are you going to do there? There’s not much surgery that can restore that. Again, unless there was something big and pressing and usually, that’s not the case.
Usually there are ways, especially with the thoracolumbar disc disease, where we can use acupuncture and such to help restore neural communication. But of course, you have to work this out with your vet. And so, I’m not saying that’s always the case. That has to be on a case-by-case basis. And I am not your physician or your veterinarian. So, that’s my disclaimer is you need to work that out with your vet and the people that care for your animal.
But what happens after that initial injury? Whatever it was, it’s the long-standing part that comes after that, that really causes the problems. And that’s called the secondary injury phase of spinal cord injury is spinal cord pathophysiology.
And that involves all kinds of things that are mediated or brought through the blood vessel system. And you’re getting inflammatory factors being released. So, some changes in the biochemistry. And that is going to be what determines the long-term morbidity or illness and ability to recover. What do we do with the pain? There’s all those different types of back pain, neuropathic pain and so on.
So, so many lives get saved with these techniques. And whether there is surgery or not, they are important to have as options and they should be offered right from the get go. And we’re identifying areas of tension. We’re addressing things specifically and not with woo woo; with actually feeling with our hands, doing rational, good, gentle, careful, Fear Free physical exam and treating what we find appropriately.
So, massage has evidence for patients with spinal cord injury. Of course, we see pain, stress and muscle soreness in dogs after back surgery. Why is massage not standard of care should be offered all the time.
Photomedicine is important and it’s shown to have significant effects on spinal cord injury. Should be standard of care across the board, first line treatment, all kinds of things.
And then we can talk about botanicals. It has to be done rationally. It has to be done legally and safely. People need guidance to integrative medicine and rehab can change the diagnosis because we’re doing better physical diagnoses. We’re spending more time, we’re asking more questions, we’re using our hands, we can help patients avoid surgery. We can give you your options; tell you the pros and cons of each, and you can make your informed decision. It can help renew hope, provide comfort, improved spinal cord health, restore functional mobility and so on.
So, we take that information and what else can we apply that to? Well, there’s a whole host of orthopedic surgeries. So, when I showed you the information about medically unnecessary or excessive surgeries in humans, that’s in humans. And again, there’s more written, there’s more talked about, there’s more people in that field. But the only one I could find, the only reference I found in veterinary was this review of medically unnecessary surgeries in dogs and cats from JAVMA, 2016.
And yeah, this is important to consider. And we’re talking about tail docking, ear cropping, dew claw removal, ventricular cordectomies, defanging; all this stuff, which is important to talk about and think about what we should do as veterinarians. But that’s not about cruciate injury and TPLOs.
So, let’s look at the estimate of the annual economic impact of treatment of cranial cruciate ligament injury of dogs in the United States. And so, this was a long article. I just took out this, quote;
“Rupture of the cranial cruciate ligament is a prevalent, costly surgery.”
And just looking through JAVMA and the debates about things and yeah, it’s like one of the most commonly diagnosed ailments in animals and it’s very costly to address, especially with these surgeries, TPLO especially, TTA.
And I just liked how there was this rebuttal here; this letter to the editor questioning this very pro-surgery article. Because so many of the articles that surgeons publish are pro-surgery and they might be like, “Oh, TPLO’s better than TTA” or this or that or the other one. But they’re not comparing surgery to acupuncture, photomedicine. In general, they are not doing that. And when I have seen an attempt with this one laser study, it’s like you didn’t even use the proper methodology to assess this.
So, anyway, here’s the rebuttal;
“Of particular concern to us; dogs still demonstrated clear functional impairment after surgical correction with mean peak vertical force. 50 percent of body weight at a trot in 38 percent of body weight at a walk for both groups, 12 months after surgery.”
And so, this was comparing one surgical technique to another surgical technique.
Dr. Moreau says;
“Such low peak ventricular forces are a hallmark of osteoarthritic lameness in dogs.”
So, for the clients that are here, if the person who’s evaluating your dog and saying, “You need to get X surgery” (Typically a TPLO) or “You are immoral if you don’t get your dog surgery right away because your dog is going to develop this horrible arthritis unless you go. And time is of the essence and you need to go right now and you start saving the other leg,” realize that that is not true.
And that’s where I have the empowerment piece. I was like, “Go to pubmed.gov,” as I have people in my courses do, and I say, “Find me the evidence that says with surgery you will not get arthritis or as bad arthritis.” Because oftentimes, you can get more arthritis and dysfunction and crazy secondary injuries and stuff like that.
And then he concludes with these concerns in mind;
“The benefits of surgical correction for dogs with cranial cruciate ligament disease remain unclear.”
And that is the truth; there is a lot of unclarity. Even though vet students, vets, surgeons have been conditioned to say, “Oh, surgery is the gold standard is the gold standard. Oh, TPLO is the gold standard.” So, don’t believe that your dog will have chronic pain for life without the TPLO because that is not true.
And here is a study by people out of Finland that I like reading their stuff a lot. But they said;
“Use of an owner questionnaire to evaluate long-term surgical outcomes and chronic pain after cranial cruciate ligament repair in dogs, 253 cases.”
And for those that say, “Well, it’s a questionnaire of owners”, their approach is like, well, these are people that live with them all the time. They can tell how they’re doing. So, there is reliability in that.
And that they conclude, based on several pain-related questions, many more dogs than expected were found to have signs of chronic pain a mean of 2.7 years after surgery – after cranial cruciate surgery. So, years after, they’re still having chronic pain.
So, again, why is it considered the gold standard? Is it really any better? You can see other papers that are saying, “Well, after about a year, they all come out the same.” So, why did you put all that metal into this animal that you can’t retrieve and that’s going to cause problems?
And so, when we say gold standard, oh, well, what kind of gold are we talking about and whom is it benefiting? We’re talking about billions of dollars that is this injury.
So, just as an aside, remember, we talked earlier for the human about how money is driving this, whether it’s a surgeon in private practice or a big corporate practice or big surgical network or whatever. Let’s be reasonable and say a TPLO is $6000. And there are surgical practices that would do five a day. So, there could be ones that do many more or a few less. But I think five is a reasonable and six is reasonable; 6000. So, $6000 times five surgeries would be $30 thousand a day.
Now, if you do thirty thousand dollars a day times every day, even if it’s not the same surgeon, if you have other surgeons in there and they’re sharing, so that’s $150 thousand a week, if the clinic offers surgery every day.
And why I did this math myself is that you can find more information about statistics of earnings and everything in human medicine. I’ve looked and looked and looked. I’ve seen before that cruciate surgeries, TPLOs, those are billions of dollars of business a year. But I can’t find any primary research for that. And I think it’s because people don’t want the public to know.
So, anyway, you’re making 150 thousand a week because every day you’re bringing in $30 thousand. That’s 150 thousand per week. And if we give people two weeks off, say, 150 thousand times 50 weeks is $7.5 million a year. That’s for one practice where they are doing these five surgeries a day. So, just in general, ballpark.
Now, if we say seven and a half million dollars per surgeon or per surgery practice per year, I think that’s a reasonable restrained number, times a thousand board certified American College of Veterinary Surgery diplomats. So, you have at least what I had consulted was that there was like 2200-or-2400 boarded surgeons from 2019 or something like 40 something percent of those were small animal, general and orthopedic surgeons.
So, I said, let’s say we have a thousand board certified surgeons that are taking in $7.5 million per year for small animals, that’s $7.5 billion a year for this industry. And that’s only talking about board certified surgeons.
I mean, I’m just kind of bringing these figures together. But there are so many people that are doing TPLOs, taking a weekend course and doing it poorly, typically as evidence shows. So, you have a lot more surgeries than that.
So, how many billions of dollars are being spent annually on dog leg surgeries where they are doing such massive complications, such massive traumatic injury? And obviously, I am not a fan of this. And again, watch my video on The Tragic TPLO.
But then that’s just for the surgery itself. What about when there are complications? Who pays for those? You do or the client? And that’s more revenue for the clinic, too, if you’re going back there. So, we’re tacking it on.
So, who pays for the second surgery when an implant fails or you need to remove it or something or a hardware or something happens, something ruptures? You pay for that. Unless you want to cut the leg off; you’re paying for that, too. Unless you’ve got to pay for euthanasia; you’re paying for that and then you’re regretful.
Why is surgery not better scrutinized? Who is not afraid to speak out against the machismo of orthopedic surgery? I guess me, right? But you hear, “Oh, so and so doesn’t like TPLO, or this or that.” They’re never speaking out. So, who’s even learning about this? What clients are empowered to ask questions, to debate, to go somewhere else?
We know in our scientific integrative medicine CuraCore community, we have so many people that are hiring other people because they’re so busy they can’t keep up because clients are finding them. But there needs to be so much more. This needs to be taught in school. Here’s your tibial tuberosity advancement. How comfortable does that look? That is crazy traumatic. So, why are you not given options enough, especially when you’re just being convinced that this is the gold standard?
So, what we want to do is encourage treatments that are going to stimulate the body to repair itself. We know that even in human medicine, there are no evidence-based arguments to recommend a systematic surgical reconstruction for their ACLs in the human. And knee stability can be improved not only by surgery, but also by neuromuscular rehabilitation.
So, integrative rehab, whatever the treatment, fully normal knee kinematics are not restored. So, whoever says that TPLO dog knees are the same as they were is completely misled, because you’ve changed the anatomy, you’ve changed the function, you’ve got all the swelling and it’s just — I just am not a fan again.
What would you want if this was you? Would you want your tibia cut and then plated it in a different position? I don’t think so. What’s that going to do to your back, to everything else?
Again, watch my webinar. There’s no reason to rush into surgery. You can do integrative medicine first, especially even more clear for the chronic situation that is cranial cruciate disease in dogs.
Certainly, there are questions with disc disease, but there’s so many animals that respond beautifully and relatively quickly to just integrative medicine and rehab. So, we need to shift that mindset. We need to have more research. But there are definitely options. And you don’t have to just have euthanasia or surgery as your only options or real high-dose steroids.
So, I think that the medial buttress sign is a good sign. It’s helping the body stabilize. It’s helping to give you more surface there for the femur to lie on. And yet, in this Today’s Veterinary Practice article, it says that you find a medial buttress and that provides ample indication for surgical joint exploration. Why? Even in the absence of cranial drawer sign?
I think this is just showing the mindset that’s out there and how let’s drive them. Let’s rush to surgery. Let’s rush; whether or not you’re doing imaging.
I mean, you can see that in the human medicine, as I started out with and then drawn into the veterinary practice. But you have many options other than surgery.
And so, let’s ask, “How do they compare?” When you go to consult a practitioner, let’s say, “Would acupuncture, manual therapy, massage, herbs, laser, would it ever cause this kind of an infection?”
Look at this bone plate here and this infection after the TPLO, the bone plate here with this biofilm, this resistant organism, the cost. This is a vet who she did not want a TPLO and she felt she was kind of pressured into it and resistant bacteria. Her dog was hospitalized with wound suction for nine days in the ICU. Wound was kept open through till mid-September.
Her cost for that TPLO was $18 thousand and the dog had a resistant organism. The only thing susceptible was Amakacin, and she talked to the microbiologist at this university center and the microbiologist said, “Surgeons can’t expect to do that much manipulation to tissue without a significant risk of infection.” And then she asked, “What is the true rate of surgical infection?” It isn’t that few percent that is reported. So, underreporting.
When she was having this dog post surgically and seeing all the swelling and redness and heat being told, “Oh, you must have let him move around too much. So, that must be it,, until she brought him in and they found this problem and they put him on the ICU floor there with that Amakacin drip.
And she had the realization herself. So, for clients out there, vets get hammered, too. Vets get just kind of intimidated as well by surgeons and this prevailing kind of structure and mindset and groupthink.
She said, “I know I have told people that when a TPLO goes bad, it goes really bad. I don’t think I could have imagined what my dog went through.” And reflections later on, on her own practice, she said, “I did have an old client reach out recently for an acupuncture consultation with a dog that was three legged, 35 pounds, not a big dog. And you’re carving up little dog legs as well. And even cats getting TPLO, I think that’s just so abysmal.”
And when she asked what happened to his leg, they said, “He lost it from complications from TPLO, fracture, infection, then amputation.”
How much did that cost to lose your dog’s leg, who I know should never have gotten the TPLO? Again, they were not prepared either. All that pain, expense, trauma and exhaustion and not prepared, not offered non-surgical alternatives.
So, think what that does to the clients, to the animal, to the vet, to our profession, when we’re pushing something that is so tragically flawed. And here she is heading back to the university for removal of the bone plate with her dog there and suffering those consequences.
Here’s one year later; all that atrophy. This is that huge surgical scar. He wouldn’t even allow anything to touch it. She couldn’t even do laser therapy with him because he was so neuropathically wound up for good. Maybe an Assisi loop, electromagnetic field loop there wasn’t touching, but it was so painful still.
And then there’s this; cancer. When I started to write about cancer and TPLO, even from my own colleagues locally, I got all this push back, “Oh, it’s just a case here and there. It’s nothing. You’re making too much of it.”
Surgeons gave me a lot of pushback, “Oh, osteosarcoma. Oh, it’s just here and there. Maybe it would have happened anyways.” “Oh, now in 2014, there’s 29 cases.” Okay. “Oh, 2018, association of the tibial plateau leveling with proximal tibial osteosarcoma in dogs. Oh, you mean it’s really a thing?” That there’s 40 times higher risk of osteosarcoma in dogs when you do a TPLO.
How many of our clients, how many of you clients have been told all the risks that you’re putting your animal up against with this kind of surgery or is anybody telling you about this even; corrosion and ion released from these plates, perioperative problems.
And again, we’re kind of out of time, so I won’t go into this. We talk about it more in The Tragic TPLO. But there’s just so many things; bad things that happen. Bad, expensive, painful, damaging lifetime problems that happen with the TPLO.
And who knows what the real risk of that is. But even if they come out supposedly well, the way I’ve seen surgeons say, “Oh, that dog looks really good.” I mean, their limb is not moving normally. If their limb isn’t moving normally, their whole back is not moving normally. Did they have an adequate neurological exam? Are they suffering from neurologic complications as well as the TPLO? And what are they destined for in terms of chronic pain; patella tendon thickening, all kinds of things.
So, why not try non-invasive options first? There is no harm in that. No harm in that. If you have a solid practitioner, which is who we train. Photomedicine goes through, again, mechanistically like with the intervertebral disc disease and spinal cord injury, we’re meeting problems, we’re meeting disease with mechanisms that heal the inflammatory process, the edema, the tissue breakdown.
We’re improving circulation, endurance, comfort, joint mechanics, balance, strength, sensory motor integration, reducing pain, supporting for the time being, supporting that leg, that limb while it regains strength, giving that animal confidence to bear weight.
Medical acupuncture and related techniques for all of the above that we were just talking about, deactivating trigger points, increasing proprioception from places like this pes anserinus. So, for the vets, you’ll know what this is, this confluence of tendons; the sartorius, gracilis and semitendinosus, that each have supplied by different nerves; the femoral, the obturator and the tibial branch of the sciatic nerve.
This is such a huge, super huge, important site that is conveying so many afferent signals to the brain and spinal cord for proper integration of impulses and stiffening or relaxing of various muscles so that you can keep that joint, keep that knee joint where it is going to be stable and not overdo it in this medial side of the human leg from my human book, Interactive Medical Acupuncture Anatomy.
And here, what are they doing with a bone saw, this hardware, with the TPLO? They’re going right into that region and destroying those sensitive fibers. How can it become any more plain that you are just destroying all kinds of restorative opportunities for this animal’s tissue? Why would we do that first right out of the bat, as soon as possible, before the dog heals on their own? And it was just a trigger point that’s better now.
So, people call me from various countries and when they’ve seen my work and criticisms of the TPLO on the internet and say they’re getting pressured, the intimidation tactics are so strong. And I just try to empower them with knowledge and say, “Read this, read that, go find somebody else to give you another opportunity. This is not an emergency. You don’t need to rush.”
Because, again, many of them will turn around in just a few days, it wasn’t a cruciate injury at all. It was something else, probably some kind of myofascial issue.
So, don’t we want to know what your options are? Don’t you want to know what your options are? Yes.
So, scientific integrative medicine and rehab as first line care; that’s my goal. That’s where I want veterinary medicine to have its destiny, where we are making it kinder and more palatable and more effective and less traumatic and less fearful.
So, for those of you that do need to find a practitioner, if you go to curacore.org, we have the medical side, which is the human side and the veterinary side. You go to the veterinary side and you see this “Find a Practitioner.” So, if you’re looking for somebody near you, this is where our acupuncture course grads are and many of them are now signing up for the rehabilitation course.
And we also have a PRIMA certification where you are fully-fledged, fully imbued with all kinds of integrative approaches and you know, in a scaffolded manner, you have the foundation of all the mechanisms of action of how they work, and then you have that flexibility and that knowledge of how to apply acupuncture, medical massage and botanicals and rehab and laser therapy or LEDs for any condition, so that you have that empowerment yourself as a veterinary practitioner to utilize various modalities alone or in conjunction to bring to bear on all kinds of problems that animals may have to thereby reduce reliance on medications and surgery. So, as we say, “No woo woo, just science.”
So, thank you for joining me. Thank you for sticking with me. Our website again is curacore.org/vet, which is the vet side. For those of you that are on the podcast, again, feel free to email me or call me firstname.lastname@example.org. And if you want the visual part, go to YouTube and you’ll see the video for this: https://www.youtube.com/watch?v=In-H276ZirE
Okay. Well, thank you, everybody. We’ll delve more deeply into spinal cord injury next week.
If you’d like to learn integrative medicine from a scientific perspective, visit us at curacore.org. Thanks for listening to another installment of Surviving Veterinary Medicine.