Kezia's ACL surgery

Introductions
This is Kezia. Pronunciation rhymes with amnesia and is a derivative of a Hebrew word for cinnamon tree - chosen to describe our Siberian Husky's unusual color.  Kezia and her brother Loki (named for the Norse god of mischief) were born January 30, 2003 and have been members of our family since weeks before then as we anticipated their arrival.

The Incident Thursday, August 4, 2011 ~ 8:30am

Halfway up the stairs, where they turn at a landing, Kezia cried out in pain and halted her ascent. She yelped again and again but eventually limped her way to the top. She stopped crying and laid down so after offering some comfort by way of pets and smooches, I left her alone hoping that The Incident was merely a brief moment of discomfort.

Serious
When Kezia attempted to walk, she held her back right leg above ground, awkwardly hopping on three good legs to avoid putting any weight on the fourth. I palpated her paw and ankle, flexed and extended her leg, hoping to discover the source of the pain, but Kezia never winced during these attempts. Through a concerned phone call, Gary and I agreed Kezia should see a veterinarian. Our usual vet is not nearby, so I clicked around online and discovered a walk-in clinic here in town.

I loaded up both dogs and packed a picnic for Madelyn and me, knowing a stop at the park afterward would make the excursion more enjoyable for all.  I was impressed with the walk-in vet clinic: no appointment necessary (or even accepted) and a very short wait.

Diagnosis
The doctor asked a few questions and then knelt to check out Kezia's leg. Within moments he elicited her yelp which immediately confirmed a diagnosis. Kezia had torn her Anterior Cruciate Ligament (ACL) - an injury most common in serious athletes.  

Do you know where a dog's knee is? For all my education in human anatomy and physiology, I've never really thought about a dog's knee, which forms the rounded front of the hind legs.

The veterinarian performed the action in the right photo to determine that Kezia's tibia freely moved forward away from her femur--no longer held in place by the connective tissue between them.  You can see that if Kezia were to step on that foot, the tibia would slip right out from under the femur, causing collapse. He explained that knee injuries are very common in dogs because their knee joints are constantly flexed; there is always pressure on the knee. It would be like walking around in a half squat all day. 

This news was fairly shocking to me, as I suspected a minor twist or strain, not permanent physical damage. 

Prognosis

The only way to correct a torn ACL is through surgery. The veterinarian showed me the procedure on a tiny canine skeleton, but explained that he isn't comfortable performing it and recommended a highly skilled surgeon in Portland. When he awaited my response I said quietly, "It sounds expensive." Probably around two thousand dollars, he told me, and my chest tightened a little as I gazed at my poor puppy. 

I paid my bill for the visit and numbly took the sheet of paper with the referral hospital's information from the receptionist. I tried to remain calm and control my shallow breathing for Madelyn's sake as we climbed back into the Yukon. But when I called my husband at work to share the news, I couldn't hold back tears. In addition to the sadness of seeing my baby in pain, we are in the process of moving to a new house (including making some minor-but-still-costly renovations) and were set to leave on an exciting-but-unavoidably-expensive family vacation in just over one week. This unanticipated expense was surfacing at a very bad time. 

More Bad News

I called the clinic suggested by the vet. The surgeon would not be able to see us for a consultation until the following Friday. I was not interested in allowing Kezia to suffer for another week, plus that would be the day before our vacation departure so there would be no time to perform the operation before we left town. The receptionist gave me phone numbers for two other pet hospitals. Even though I'd already heard the estimate from the first vet, I decided to ask for a ball park figure for the surgery--just in case he was wrong. It turns out he was wrong.  Without an apologetic note in her voice, the receptionist delivered their price: $3,400 to $3,700. "And I think we're all about the same" she said, referring to the other phone numbers she'd provided. 

I hung up the phone in shock. I thought two grand was exorbitant; nearly double that was simply outrageous! Madelyn was getting restless in her carseat, so I started driving toward the park, piecing together all this information in an attempt to determine a solution to the puzzle. 

The Picnic

I wasn't really in the mood for a picnic anymore, but I knew Madelyn was still counting on it. Because we had the dogs with us, I decided on a whim to go to the playground that also has an off-leash dog park nearby. Kezia might not have much fun, but at least Loki could burn off some energy. As we pulled up to the playground, I told Madelyn we'd take the dogs to their park after our picnic. But Madelyn suggested we have our picnic in the dog area instead. Normally I'd insist we stick with my plan because it's kind of gross to eat in the dog park. Perhaps I wasn't of the mindset to explain right then and I think I found Madelyn's desire to share our picnic experience with Loki and Kezia endearing at that moment, so I turned around and we carried our adorable picnic basket through the double gates along with one fit and one disabled dog. 

The Stranger

There were two other dog owners in the park, possibly judging my parental aptitude for allowing a child to dine amid feces and urine but I didn't care. There is a picnic table, sheesh. The young woman sitting there said kindly, "Do you know your dog is limping?"

I nearly lashed out screaming at her that of COURSE I know my dog is limping do you think I am some kind of IDIOT she is literally walking on three legs it's not like I am BLIND what kind of heartless IMBECILE do you think I am?!? But I resisted and simply replied that yes, we had just come from the vet. And then sniffled. 

I'm sure I already looked quite dejected, and then I called Gary with the Bad News described above. Thirty-seven hundred dollars. More tears. Especially when Gary reluctantly brought up Kezia's relative age and life expectancy. I mean, I completely understand the humanity of putting down a dog that is deteriorating--dying. If there isn't quality of life left to be lived, then euthanasia can be a loving option. But an injury with an available solution is not the same, and the idea of putting Kezia to sleep felt to me simply like murder.

I finally sat, wiping tears, adjacent to the young woman who also had two dogs with her. Her Golden Retrievers were lying panting in the shade under the table, and the white hairs freckling their faces told me they were probably older than my own dogs. She inquired--about the tears, the limping dog--and I told her Kezia had torn her ACL and it will cost over $3,500 to fix it and we don't know what we're going to do. 

This girl shared that one of her dogs had a tumor removed a few years ago. She was told the surgery would cost $2,000 but a vet in Astoria removed it for $500. Before leaving, she expressed her well wishes and I memorized the name of the veterinarian and his clinic in Astoria. That is 90 minutes away from home, but it would be worth it if the surgery could be done for a fourth of the anticipated cost! Using that math, maybe we could make Kezia better for around $800 instead. I left the dog park with hope.

Research

I Googled Columbia Veterinary Hospital and found the recommended Dr. Goza in Astoria. But each time I tried calling the line was busy or they were closed for lunch. Meanwhile I called my mom and my closest friend for some sympathy. Barb recommended a local vet, which led me to another series of phone calls. Throughout the day I researched torn canine ACL and the surgical options on the web and youtube, periodically shedding a few more tears. Madelyn didn't like it when I cried. Each time, she pulled out a blank birthday card from a box in my office, colored in it, and gave it to me to help me feel better. 

When Gary got home from work we discussed everything I'd learned: one vet was out of town, one recommended waiting until after our vacation to do the surgery, none would give me an estimate on the cost because "it depends on a lot of factors." I realized then that I still hadn't reached the clinic in Astoria. It was after 5pm, but I decided to try again in case they were still open. 

Finally, Good News

Dr. Goza at Columbia Veterinary Hospital could see Kezia the next morning and perform the surgery that evening. Since we live out of the area (and I had to return to Aloha for our big remodeling project at Curves scheduled that weekend) we were invited to leave her overnight. We got a ball park figure here: three to five hundred dollars! I find this difference mind-boggling! And we were finally filled with relief that we could help Kezia without severe financial burden.

Columbia Veterinary Hospital

Madelyn, Kezia, and I left Friday morning and drove an hour and a half to Astoria. The clinic was dim and not especially clean. The building caused faint memories of summer camp mess halls and health clinics to surface. None of the staff members wore scrubs or a uniform of any kind. They all--including the doctor himself--sported jeans and ill-fitting tops that appeared to have been purchased in the nineties. Dr. Goza reminded me so much of an actor I couldn't place. Thanks to IMDb, I later determined it is Spalding Gray, an obscure memory indeed, as I've only ever seen him in Beaches many years ago. But he also looked a little like "Doc" from Back to the Future--sort of a mad scientist vibe. 

I didn't take any pictures of Dr. Goza myself, but here is one I borrowed from this nice tribute to him. 

Dr. Goza was friendly, yet to-the-point. His objective was to make my dog better and he knew how to do that.  After telling me nonchalantly that the operation would cost $300, he offered an unsolicited explanation for the hospitals in Portland charging $4000 because "if you can't pay it, someone else can." He went on to say that in a small town, he simply can't watch all the dogs limping around. I kissed Kezia goodbye, he led her into the back, and that was that. 

Post-Op

After another 90-minute drive the next morning, Madelyn and I greeted Kezia back at the clinic. Her leg was shaved and 18 stainless-steel sutures lined the 5-inch incision along her knee. She was a little out of it and drooly because of the pain medication. Dr. Goza said that the surgery went perfectly. Kezia's Cruciate Ligament was completely severed, but her knee was the perfect surgical candidate. He commended us for bringing her in right away and complimented Kezia's overall physical condition, which benefits the surgical outcome and her recovery. 

After thanking Dr. Goza, I slowly led my hopping dog to the front desk to pay. There, she got a lot of sympathetic looks and comments from other waiting pet owners.  With Kezia's two prescriptions in hand, I started writing the check. "Three hundred dollars" the receptionist said. I reminded her that I also had two bottles of pills. "Yep, three hundred dollars."

Incredible. ACL surgery, pain meds, and antibiotics for $300. It was already such a good deal, I would not have balked at an additional cost for the pills. I should mention that Dr. Goza performed a different procedure than the one we would have likely paid for in Portland. I read all about the newfangled surgery called TPLO (Tibial Plateau Leveling Osteotomy) but Dr. Goza said 75% of vets still do what he does and it is nearly as effective for a much nicer price tag. 

The morning after surgery

Close-up of incision

Sleepless Night

The first night at home was tough--Kezia seemed to be in a lot of pain and let us know it. I eventually slept on the floor with Kezia, mainly in an effort to facilitate a better night for Gary so he could be rested for work. I discovered that when Kezia starting whining I could help her calm down if I was close. Also, a few times in the night she struggled to get up, then walked around aimlessly. Since she couldn't easily go downstairs to the dog door, I put her on leash and took her out the front door a few times, although often she would stand there without relieving herself. It was confusing and frustrating not knowing how to help, not wanting a mess on the carpet inside, wanting her to be comfortable, but also yearning desperately for sleep. It was much like having a newborn baby. Thankfully, after the first night she didn't seem to be in as much pain. 

20 Days

As I mentioned, we took a vacation a week after Kezia's surgery. She and Loki boarded in a kennel operated by a friend of mine on her farm. I was glad to be leaving Kezia with someone I knew personally in her condition. While we were gone Kezia did a lot of healing and she is now lightly putting her foot down when she walks much of the time. The fur is growing back on her leg. We are so relieved with the outcome of what began as a very emotional day. 

August 25, 2011 - 20 days post-op

Close-up of incision

In Conclusion

I feel like this outcome was somewhat miraculous. I never would have known about Dr. Goza had it not been for the kind stranger who felt compelled to start a conversation and share with me. Had I responded rudely when she asked about Kezia's limp, she may not have done so. Had we eaten our picnic at the playground first, she might have been gone before we arrived. We so rarely go to that dog park anyway, it was an amazing coincidence to be there at all. I want so badly to thank this young woman and tell her it all worked out wonderfully, because of her. As for the vet who referred me to the expensive surgeon, I'll probably bring Kezia there next week to have her sutures removed, and I plan to explain our story and urge him to let patients know about other, more affordable options.