June 11, 2025 • 46 mins
This week on In The Vet’s Office, Dr. Josie Horchak is joined by board-certified veterinary surgeon Dr. Marta Agrodnia for an unforgettable deep dive into some of the most intense cases in her surgical career. From removing a 12-pound tumor from a Labrador’s chest that was crushing his esophagus, to diagnosing a football-sized adrenal tumor in a 170-pound bloated Great Dane—Dr. Agrodnia shares how both dogs went on to beat cancer.
They discuss the most common surgeries she performs, including Tibial Plateau Leveling Osteotomy (TPLO), the canine equivalent of ACL surgery. You’ll also hear about cutting-edge treatments for arthritis like Synovetin joint injections, and complex soft tissue surgeries involving mast cell tumors and soft tissue sarcomas.
Dr. Agrodnia also shares a rare and fascinating case involving a monkey with a cancerous arm mass, and the surprising similarities between monkey and human blood supply that made the procedure especially challenging.
Throughout the conversation, Dr. Horchak and Dr. Agrodnia explore the emotional realities of veterinary care—including how they respond to the question they hear so often: “What would you do if this was your pet?”
This episode is packed with insight, heart, and extraordinary stories that will forever change the way you see the vet’s office.
See omnystudio.com/listener for privacy information.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:08):
You're listening to In the Vet's Office with doctor Josie Horshak.
Speaker 2 (00:16):
All right, everyone, welcome back to in the Best Office.
I am your host, doctor Josie, and we have a
very exciting episode today because we are joined with an
incredibly accomplished guest, doctor Marta Agrodnia, a highly respected veterinary
surgeon with a deep passion for advancing animal care. Whether
she's in the o R, mentoring young vests or advocating
(00:36):
for the well being of her patients, Doctor Grodnia brings skill, compassion,
and innovation to everything she does. Welcome to in the
Best Office.
Speaker 1 (00:44):
Ah, thank you so much for having me.
Speaker 2 (00:47):
We have had a couple specialists on. I've had an oncologist,
a nutritionist, an internis. But you're a first surgeon.
Speaker 1 (00:56):
Yeah, fabulous, I know.
Speaker 2 (00:58):
So we're excited to have a lot of my job,
you know, as a veterinarian is managing things medically, but
there's also a large portion that requires surgery, and some
of which I'm able to do as a general practitioner,
and then also a fairly big chunk that we ship
off to you as a board certified surgeon. Do you
(01:21):
mind explaining a little bit what the difference between me
as a general practitioner and the difference as you as
a surgeon? What that is?
Speaker 1 (01:28):
Sure?
Speaker 2 (01:29):
Sure?
Speaker 1 (01:29):
So in human medicine it's very similar. We all go
through four years of medical school and at the end
of that we're all doctors. But on the human side,
they have to go on and do some type of
residency training, be it family practice, orthopedic surgery, dermatology, cardiology, something.
(01:49):
On the veterinary side, around five percent of us after
veterinary school go on to do advanced training with internships
or residencies. So after four years of veninorary school, well,
I did additional four years of the anestesian searchicle training
to become a board certified surgeon.
Speaker 2 (02:06):
And I always tell listeners it's interesting because there isn't
a ton of regulation around it, like we can just
as general practitioners say, I'll do whatever I feel comfortable with,
and then when I feel like it's above my pay grade,
I ship it to you. So it's really it's kind
of interesting in the way that that works. I think
there needs to.
Speaker 1 (02:26):
Be flexibility, right, There needs to be flexibile in vendory
medicine to give people options.
Speaker 2 (02:31):
Absolutely, yes, well before we dive in and get to
show you a little bit more. I always start this
episode with the case of the week and we talk
about some sort of case that the listeners will find
interesting and kind of giving them a peak behind the
scenes of what we do in the trenches. And I figured,
who better to do the case than you? Oh?
Speaker 1 (02:53):
Sure, well, thank you.
Speaker 2 (02:54):
Yeah.
Speaker 1 (02:55):
I've been practicing for twenty eight years and there is
always an interesting case of the week, for sure, and
in our specialty practice, we do tend to see the
hard cases. Recently, I had a fun case as it
was one hundred and ten pound middle aged black lab
dog that came. The dog started having difficulty eating and
(03:18):
then finally stopped eating, and anybody who has levet or
retrievers note that is a huge red flag that something
is not right. And when the referral veninarian took chest
radiew grass, the dog had a very very large mass
inside its chest and the owners were initially told it
was inoperable. But the problem is that the dog could
(03:40):
not eat because his esophagus was completely squashed by this mass.
So he came to us for a full workup and
we diagnosed this dog with a type of cancer called
the thighmoma, and my experience with those or those challenging,
most of them can be removed surgically. So we went
in and did the surgery and removed a twelve pound
thy MoMA from the middle of this dog's chest. And
(04:04):
so this one hundred and ten pound dog became a
ninety eight pound dog and he was able to eat
the day after surgery. They pursued additional treatment with chemotherapy
and radiation therapy because these owners were all in and
he was still in complete remission ten months later. Because
I just got the feedback from this guy. So that
(04:24):
was pretty special to take a case that nothing else
was going to be able to help him and give
him back his quality of life.
Speaker 2 (04:31):
That's amazing. I can't imagine having a twelve pound can
you imagine?
Speaker 1 (04:36):
Yeah, And he kept eating, he kept going until that
esophagus was to squeeze shut and he couldn't get a
single drop in.
Speaker 2 (04:43):
That's so funny. You do say, like, we there are
some dogs out there when they stop eating, you know
it's bad, you know it's really bad.
Speaker 1 (04:50):
I myself have a black lab.
Speaker 2 (04:52):
I know. Yeah, And then you definitely you know they're
like our garbage disposals of utionary medicine exactly.
Speaker 1 (04:57):
They call him are vacuumquator. What's my husband called him?
Like pre rints or pre washed. When the dishwashers open,
he's right.
Speaker 2 (05:05):
There, He's like, I will help you. So, okay, I
feel like that's somewhat of a more extraordinary case. What
are the main cases that you're seeing on a daily
basis as a surgeon?
Speaker 1 (05:18):
Sure? So in our practice we do about fifty percent
orthopedicx fifty percent soft tissue, and on the orthopedic side,
the cruciate ligment disease is absolutely the most common thing
that we see day in and day out. It's very
rare for our hospital not to be doing between one
and four cruciate surgeries. And so that most common surgery
(05:40):
we do is called the TPLO or tibial plateau leveling osteotomy,
and that for.
Speaker 2 (05:45):
The listeners is for we say cruciate and it's similar
to an ACL tair in humans. We call it the
cranial cruciate ligaments. That it's essentially the same as the
ACL and human which I would have to assume that
the majority of a that they've had dogs, they're multiple dogs.
They're familiar with this because it is super duper common.
Speaker 1 (06:05):
Yeah, it's very common. As you said, the ligament functioned
as the same between humans and dogs. It prevents the
tibia from moving forward in relationship to the femur. But
the difference in humans, right, is that when we injure
our acl our cruciate ligament, it's always traumatic, and we
know if we go on arthroscopically the same day we
(06:27):
injure it, we get very set images that show us
the whole knee was healthy and just that ligament was
torn because we did something downhill, skiing or soccer, you
name the sport and it can happen. But in dogs,
it's a degenerative process to that cruciate ligament, and if
you go even the same day, owners see the lameness.
The arthroscopic images are completely different, and that ligament's been
(06:49):
degenerating over a period of weeks, months, maybe even years
before it finally starts to shred and tear and the
dog becomes lame from it.
Speaker 2 (06:58):
It's interesting because we see I see a lot of
clients where we suspect the cruciate hair, whether it's partial
or full, and clients really struggle with it because one
day the dog looks fine, yeah, and by fine I
mean like not super duper lame, and then the next
day it can be really augay and limping, and so
it's kind of like waxes and waves, and I think
people have a hard time wrapping their mind around the
(07:22):
fact that it's probably not going to get better without surgery.
Speaker 1 (07:27):
Yeah, it is a degender process. And what I explain
to owners because sometimes owners think, oh, I shouldn't let
my dog exercise because that's why they hurt their knee.
I'm like, no, No, Having strong thigh muscles is protective
of the cruciate ligament, just like in people. In fact,
in dogs, the only breathe that doesn't get crushiet ligament
disease is the greyhound because their thigh muscles are just
(07:49):
huge compared for their body weight. So we want them active,
we want them fit. It still happens in somewhere between
ten and fifteen percent of dogs, and the reason is
because they're canines. It's a species related problem. So in humans,
if you're standing straight up, the top of your tibia
bone is like a tabletop to the ground. It has
a downward slope between three and seven degrees, and the
(08:12):
wolf has been radiographed, and interestingly, their downward slope is
between nine and ten degrees. But the canine species, it
doesn't matter if you're a labrador or super mutt, because
they have a couple of those two. It's about twenty
five and a half degrees, so it's about five times
steeper than a human. So the femur is naturally falling
off the back of the tibia, and it's that cruciate
(08:33):
ligament that holds it up there, and that's why it's
so susceptible to that degenerative wear and tear break down,
so that the fibers degenerate and then the tearing starts
and eventually it will completely tear. So in those partial cases,
the evidence is becoming stronger and stronger that we should
go to surgery sooner because you maintain them the niscal
(08:54):
health because canines little doggies have miniscal carlage just like
people do, and maintains the overall cartilage health and the
me so the sooner the better, the sooner the better.
I do recommend operating on partial tears, and I don't
say that lightly because I do a lot of training
of surgeons, and I have a of my personal children
(09:16):
is actually in human medical school and he wants to
become a human surgeon. Why humans, I don't know. I
have no idea, but that's what he wants to do.
But the point being is that surgery can always make
a patient worse, so you have to be very thoughtful
about that and always look at the risks versus the benefits.
So with these partial tears, it took me a long time,
(09:39):
and I've been practicing almost thirty years to really feel
confident that we are doing our patient's a service by
recommending surgery sooner rather than later. And at this point
in time in my career, I am one hundred percent
behind taking partial tears to TPLO surgery and the evidence
supports that. In fact, just of NUO Orthopedic Society conference
(10:01):
this year, they did some really nice work showing that
the longer animal is lame, it actually does affect the prognosis.
Speaker 2 (10:10):
Yeah, I mean that that definitely makes sense. And having
had a dog that's had two TPLOs, one on either side,
and I will say to listeners, and I'm sure you
will concur that if your pet here is one apl
or CCL on one side, they are very likely to
hear the other on the other side. So I just
kind of pep Boner.
Speaker 1 (10:30):
For that was true. It's true. Really, it depends upon
their age. So when they are seven years or younger,
it's more likely than not that the other side is
going to go. And why one side precedes the other,
we don't know. It's just it's just always has But
it's true when they're younger this seven years, but it's
also good to know when they're eight years or older.
(10:53):
It's actually like flip so that it's somewhere around seventy
seventy five percent likelihood if they're under seven, and it's
about only twenty five percent or so if they're eight
or older. So if it is an older animal, you
can kind of take a little bit of a side.
Depends on how you view that glass of water, right,
but it is if your dog is eight years or older,
(11:15):
the chances are you'll only have to do one side.
Speaker 2 (11:19):
That is interesting. Yeah, I guess it depends on how
you look at the glass of water, half full or
half half empty.
Speaker 1 (11:25):
Yeah, But and it's important to know that that is
an age difference that we appreciate now that we didn't
always appreciate, and.
Speaker 2 (11:34):
I do have a lot of owners say, I feel
like we've really gone down this rabbit hole of PPLOs.
But this is important because I know it's a lot
of what's so common, right and so common. I have
a lot of owners sayed to me, oh, I'm so
worried about the postop experience, twelve weeks of postop recovery
and experiencing it myself. Of course, twelve weeks is a
long time, but they do remarkably well. I find that
(11:56):
the majority, the overwhelming majority of my patients that do
have eplos go on to have a great prognosis.
Speaker 1 (12:03):
Yeah, and it's helpful. I can speak to it as
well from the client experience side, having two dogs that
had four knees done. So I've done over two thousand
TPLOs as a surgeon, and I've lived through the recovery
four times myself personally. And it's true about ninety five
(12:24):
percent of owners feel their dogs get back to ninety
five percent or better. But there's there's reasons why we
don't have one hundred percent. And that's also where we
talk about arthritis and how we treat arthritis, and I.
Speaker 2 (12:37):
Think you know a big portion of that too is
you know, setting expectations that your pet has injury in
its joint space and that does predispose it to arthritis?
Are there? I guess we should probably jump into arthritis
in general.
Speaker 1 (12:53):
That's what a great segue.
Speaker 2 (12:55):
I am sure that you probably see a lot of that.
How well, I guess for the listeners, what are some
signs that they should be looking for at home that
their dog may have arthritis? And if they're seeing that,
what do you recommend that they do?
Speaker 1 (13:09):
Sure? Well, if their dog has a lameness, I do
recommend going to your veterinarian, you know, sooner rather than later.
And that doesn't mean the first day, you know, we
can all take a bad step and maybe the next
day we're fine. But if you're I do tell owners
to trust their gut. They know their dogs far better
than we do. They're very attuned to their dogs. If
(13:29):
you're seeing that, lamus, see your veterinarian. The first most
important step is always conservative management. Is your dog in
a good body weight? Are they reasonably fit? You know,
are they exercising on a regular basis? And once you
have that conservative management, then you can start looking at
medical management and medical management could be anything from the
(13:49):
non cridle anti inflammatory drugs, which are the scientifically proven
category to help with arthritis. There's other supplemental categories that
the science is a little bit softer, but still good
to know about, things like the glucosamine conjointans, the antioxidants.
You've got a pain control category like gaba, penton, a mantadine, tramadol.
(14:12):
Those might be appropriate more advanced cases. And then if
there's really a joint or a couple joints that are
the problem joints, you can start considering joint injections.
Speaker 2 (14:24):
There's one join injection that I have learned about fairly recently,
and there's actually a veterinarian I go to a surgeon
in Cincinnati that's using it pretty frequently. Have you heard
of sonovatin?
Speaker 1 (14:37):
I have. In fact, I've been using snosin for I
think five years now.
Speaker 2 (14:42):
Okay, have you been using it for a while? Do
you mind? I think this is a really interesting option
out there for clients, and I don't know that it's
as well known as you know putting them on remadil
or putting them on gabage London, So do you mind
just driving them. Just a little bit about what exactly
it is and how it works.
Speaker 1 (15:02):
Sure, Sonovatin is a medical radiotherapeutic. So this radioisotope, it's
technically known as ten one point seventeen M. It is
put directly into the joint. So what's great about it
is that it works at the source and its mechanism
of action is that it's taken up by macrifages and
(15:22):
sonovo sites and it then destroys those cells. So instead
of the insid category of medications that stop the inflammatory
cascade kind of midway through, like they're enzyme inhibitors, the
sonovatonoa destroys the cells that create those inflammatory mediators, and
(15:42):
so it's really hitting inflammation at the source. So it
just does a great job at stopping that inflammatory cascade,
and so it does take some time. But again, because
the mechanism of action is local, you don't have to
worry about any side effects with the liver or the
kidneys or the GI system. It's about five percent and
the dogs will have gastrointestinal side effects to the un
(16:03):
said category, you don't have to worry about forgetting, Like
I'm a doggy owner, I've got three dogs, and even
trying to remember my own dogs medication with my busy
life with kids and working is really hard. So I
don't have to worry about me forgetting the medications. I
don't have to worry about checking blood work. I don't
have to worry about any systemic side effects that they're
(16:24):
just not there. So once the medication is delivered, then
it can take anywhere from one to eight weeks to
start working because it takes time to kill off those
macrifages and snovaa sites and then all those cytokinds to degrade.
And it's also nice because this is a disease modifying device,
so it can actually change the fluid there that helps
(16:46):
keep the cardless healthy. So I'm really excited to see
what snovodan is doing now and what we're going to
learn more about it in the future.
Speaker 2 (17:05):
What would be a case like, are we talking a
dog that comes in with elbow arthritis or me arthritis?
What does that look like When you're like, yes, and
would you great with this medication?
Speaker 1 (17:15):
Yeah?
Speaker 2 (17:16):
Or advice? I should say I, well, yeah, exactly.
Speaker 1 (17:20):
It is FT approved as a device for K nine elbows,
but because of regulations are state by state, I'm allowed
to place it in any sonovial joint in cats or dogs.
So that's fantastic because although elbows are the most common,
I've placed it in a lot of knees and I've
placed it in just about any joint that I can
(17:42):
get that needle into. And you seem really good effects
from it.
Speaker 2 (17:47):
Have you done it? And I'll fay risks to keep
it simple, but the carpet, yes, okay. I have quite
a few patients with Risks arthritis, so that's interesting to hear.
And when you're doing it in me, there these of
patients that have had appreciate disease and then have had
PPOs and afterwards you're giving the induction.
Speaker 1 (18:10):
For myself. Yes, like, those are the cases I'm seeing
and I'm doing when it comes to stifles or knees,
and I have been absolutely thrilled with some cases. I
have one case that had bilateral TTAS, which is a
similar type of surgery to the TPO, similar but different,
and the surgery was done elsewhere. It was done in
New York, and the owner moved to Maine and the
(18:33):
dog remained mediocre. She came to me a year or
so after the surgeries had been done. I started working
with her making sure like did your dog suffer meniscal
injury after the surgery. We worked through some other types
of joint injections, and then back in twenty twenty when
(18:53):
I started using this, we put Shamus on the list
and said all right, let's try the Sonovatan for him.
And she contacted me two months after the device that
Snowton was placed in her dog's knees and she's like,
he's running up the mountain again. She's like, he hasn't
been running in front of me for over three years now,
(19:14):
He's running in front of me. Like she was just
absolutely ecstatic. So I think about some of these cases
and the recalcitrant cinevitis or inflammation that stays in that
joint after cruciate surgery that oral medications can't always resolve,
and I find synova tin resolves it. So I've seen
really good success following some of those TPLO cases that
(19:34):
just don't get to that ninety five hundred percent.
Speaker 2 (19:37):
I think that's really such a great option for the
listeners as owners to know that, yes, there are going
to be cases where your pet far and wide really
needs to have a proceedure done to get them the
best result possible, but then even post off if they
don't reach one hundred percent. We do have these joint injections,
or in some cases they may you may elect not
(19:59):
to do so at all and just do the joint injection.
So her pet does have really bad elbows. Writers, I'm
sure there's some cases where you would want to do
surgery beforehand, but you could just inject a joint and
they could have a great It sounds like a great recovery.
Speaker 1 (20:14):
I'm they respond, I've been using Snowton for five years
and I've only gotten happier and happier with it. My
own personal dog a full disclosure. After he had his
bilateral TPLOs and he was a really big boy. He
was running during the summer. He had his like a
TPO in December, a TPO in February. So he's out
(20:35):
running in the summer with his brothers outside and he's
laying in the front. It's like, you've got to be
kidding me, right, Like I'm the classic owner, Like no,
I just got through this TPLO recovery, Like what's going on?
And it was his elbows. So I was like, nope,
no more surgery for you. We went right to Sonovatan
and I was fortunate he was sound for a full
(20:56):
eighteen months before I had to repeat the injection. But
it was so worth not having to go back and
do another surgery for him, yeah.
Speaker 2 (21:06):
Or give him daily medications every single day, which I
know that snowakan is not inextensive. I think it's you know,
a couple of thousand dollars, but if you think about
medicating a very large dog for an entire eighteen months,
you're probably looking at no longer.
Speaker 1 (21:20):
Yeah. Absolutely, in the blood work you should be checking
in my own dog. Again, he's a big boy. He
was one who he's a rescue and he gets diary
if you look at him cross eyed. So for him
and SAIDs are just not a good option. Now it's
like I need to save my marriage and I cannot
have the dock having diary in the house.
Speaker 2 (21:39):
Yeah, I feel that to my core. I could get that.
Aside from all of the orthopedics up, what are some
of the soft tissue procedures that you're doing as a surgeon.
Speaker 1 (21:50):
Sure, well, I personally love a lot of oncologic surgery.
I love working with cancers and providing owner options. So
it might be mass sells tumors that grow, it might
be soft tissue sarcomas. Another really amazing surgery I had
just a couple of years ago they stayed with me
(22:10):
was a very very large Great Dane. It was like
one hundred and seventy pound Great Dane that had the
owner's just noticed it was getting bloated, and so it
got worked up by our internal medicine team. They said,
there's a large tumor in this dog. I don't know
what it is, but you know, we need to do
(22:32):
something about it because it was all this fluid. The
reason why the dog was looking bloated was because of
free fluid in the dog's belly. So I ended up
taking a football size You got to really picture a
football size, like a twenty five centimeter size adrenal tumor
from this dog's right side. And in addition to that,
(22:52):
the reason why the dog lost four leaders of fluid
in its belly was because it also had a large clot.
It's been a cava. So I then removed what was
about the size of an orange clot out of its
being a cava, and that dog was actually cured from
its tumor. So it is. I love doing oncologic surgery.
(23:14):
I love providing owners options in helping dogs, especially I said,
when really nothing else is going to do.
Speaker 2 (23:21):
It, you are braveful. Do you ever get nervous? Bring
for theaters or are you cool the cucumber?
Speaker 1 (23:30):
I am better as I've gotten older at managing those
emotions because every patient life means so much to us.
And you know, I was trained again, I was trained
back in the nineties, and you're supposed to like, never
tell someone what you do if it was your animal,
and I feel like I just don't agree with that
(23:51):
philosophy because what owners really want to know is that
you care and would you do this if it were
your own animal, And when they come into my sphere,
I feel very maternal about them, and so I do
have to work on that separation when I'm in the
barbum to be more of a problem solver, But that
animal feels like it's my animal, so it's hard for
(24:14):
me to completely separate that.
Speaker 2 (24:17):
I completely understand that. I think owners. I can't tell
you how many times a week I haven't owners say
what would you do with it? With your pets? And
we do have to be careful with that, but I
under percent do love their pets similar to how I
would love my own. I'd take that, I don't take
that lightly. And so I understand what you're saying completely.
Speaker 1 (24:36):
Exactly, because also I've had I'm on dogs number like six,
seven and eight right now, I've had eight different dogs
over the course of my lifetime, and they're not all
the same, and so the choices I might make for
one might not be the same. And I also acknowledge
that sometimes I'm sure I know what I'm going to
do given a certain set of circumstances, and then I'm
(24:56):
there and I make a different choice, and that's okay.
I tell me all the time, I want you to
feel supported no matter what you choose to do. And again,
when they asked that question, what they really want to
know is do you feel that there's a right way
or wrong way? And sometimes there's not, you know, sometimes
they say there are different options. It's not a right
or wrong and it's absolutly okay to choose not to
(25:18):
do something. Part of our jobs is experience, is to
give them information so that they make the decision that's
best for them. Their animal their family, their set of circumstances.
Speaker 2 (25:29):
Yeah, I completely agree. I think a lot of our
role is to be given the information, like you said,
and then whatever is best for them, help be their
support system and their experts that's going to help guide
them along the way. So have you ever done surgery
on any exotic or view animals or primarily dogs and cats?
Speaker 1 (25:51):
Yeah? I primarily just do dog and cats for sure.
I have had the opportunity to do some exotics over
the years, some ferrets or bunnies. One of my favorite
cases was a capuchin monkey because this little guy had
a cancer that was really bothering him. And this was
a service monkey, so his owner was a quadriplegic. So
(26:12):
that's a whole other level of responsibility, right. So I
did work with people familiar in the zoo setting to
help us with the anesthesia, because they're more like humans
than anything else. But that was that was actually pretty
amazing to just be able to interact with that little guy.
Speaker 2 (26:27):
I'm sorry, what kind of procedure did you do on him?
Speaker 1 (26:30):
So he got a cancer that was growing on his
ARMM and so I had to do a soft tissue
surgery to remove it, and then a little bit of
reconstruction to make sure that the skin got backward needed
to be because it's very different skin than cats and dogs.
Speaker 2 (26:48):
Is it? And what is it? More thin?
Speaker 1 (26:51):
It was more thin, And because the blood supply is
like a human right, So in humans, our blood supply
comes up directly from the tissues underneath to our skin.
But in dogs, they have much thicker skin, and their
blood supply comes up through a single major vein and artery,
So these vessels supply a whole segment of skin. So
(27:14):
the blood supply system is honest, it's just completely different
between the two. So I did I had to do
some research to make sure that I was I would
not know that, Oh, yeah, it's completely different. That's yeah.
I can explain a lot. I feel like I'm going
to go down a rabbit hole here if I get
too far, because I start getting gritty of things really interesting.
Speaker 2 (27:34):
And I'm assuming it was intubating the monkey similar. I mean,
I guess, just like intubating any other mammal.
Speaker 1 (27:42):
So the monkey. I did wonder if I should intubate
like you see on the human TV dramas where they're
behind the head and they do some type of intibation,
but because I'm a veterinarian and I'm so used to
intubating looking at the face that that's how I intubated
this little guy.
Speaker 2 (28:01):
And of all the procedures that you do, is there
one that you find to be the most challenging or
you see it on your schedule and you're like, oh,
I wish I didn't have to do this.
Speaker 1 (28:14):
I think with surgurgery, I don't think there's one that
I wish I didn't have to do. I will say
there's a couple that because they can throw you curveballs
or more stressful than other cases, like the adren electomies are,
they always have the potential to throw your curveball. You know,
(28:36):
there's no such thing as a straightforward a dream electomy.
Some of those shunts, so if dog or kitty cats
have vessels in the abdomen that are bypassing the liver,
so what we call a shunt vessel, those are also
challenging because the surgery itself can go absolutely beautifully, but
(28:57):
yet there can still be a post operative complication that
can even be life threatening.
Speaker 2 (29:03):
When I ask you this about oh gosh, I wish
I didn't see that on my schedule. I think back
to all of the general practitioners I've worked with, and
I think something that listeners don't know is that a
lot of GPS will tell you, oh, yeah, I'm fine
doing a neuter. I'm find doing a mask and reval.
I really don't like to do big dog spas, and
I don't know that the average owner recognizes how big
(29:26):
of a procedure it is. And I'm certainly not saying
don't do it, because I highly recommend it, but it's
like a pretty invasive surgery that requires quite a bit
of skill. So I always like to point that out
to my owner.
Speaker 1 (29:39):
Yeah, I do think that the veterinar profession has sent
itself at a service by minimizing the space and neuters,
because these are especially the spas, are abdominal procedures. But
even with neuters, unfortunately I see life threatening complications and
(29:59):
you will, and they are significant procedures. It's not just
the anestiegia, it's the surgery itself. So I think I
agree with you, like owners really do need to be
made aware that this is something but significant. We don't
take it lightly. We want to do it with the
utmost professionalism and the bigger the dog, the harder it is.
(30:23):
So I agree with you that it should be treated
with the significance it deserves, and.
Speaker 2 (30:29):
I think we're starting to go more that way. I
just you know, when owners get the treatment plan or
the estimate for the procedure, I think they're like, wow,
it's just a say how could it be so expensive?
And I'm like, well, just to spay is a fairly
complicated and requires a lot of skilled procedure.
Speaker 1 (30:45):
So I always to think about the IVY catheter, the
antesesian medications, the fluids, the monitoring, the instrumentation, the time
it takes. Because a large dog spae is actually a
major surgery. We also offer a laparoscopics bade Our clinic,
which is actually a lot of fun. It's a nice
(31:07):
option to have, but it's still a major ordeal because
the anesthesia involved, and that is more critical than when
you're opening the appdomen. So I absolutely agree with you.
And you know, for another thing to relate to the
GP practice is whenever I have a neighbor that talks
to me about, hey, this this practice does a dentistry
(31:29):
you know for eight hundred and this other practice quoted
me for fourteen hundred. I'm like, go to the fourteen hundred.
I'm like, you're not comparing apples to apples. I promise
you the fourteen hundred will have better monitoring. They'll have
technicians that are trained to do it, they'll have money
heating pad, they'll monitor them post you know, post dentistry.
Like that's just another one, right that you really want
(31:49):
to do it well, not just do it inexpensively.
Speaker 2 (31:53):
Exactly. It's not worth shopping around when it comes to
your pet, potentially to their life, so paying is worth it. Yeah, yeah, Okay,
anything else that you think we're missing with arthritis or
cruciate disease, anything you want to point out that you
see on a daily basis, that you recommend or that
(32:16):
we should think about.
Speaker 1 (32:17):
I think the big points yeah, I think the big
points with cruciate disease is sooner is better than later.
You do want to get them before they have advanced
cartilage damage and before the meniscus is damaged, if possible.
I think the TPLO is a great surgery. As I said,
I've done it a couple thousand times for arthritis of
(32:39):
all kinds, be it elbows or knees, the sonovatant is
a wonderful option. It provides really long lasting pain relief,
and although it works best in the earlier stages, it
can help keep that cartilage healthier longer, which is fantastic.
It also works in advance cases, and most of the
(33:01):
cases I'm still treating our advanced because these are the
owners that are turning over every stone possible and it's
still working seventy five plus percent of the time. And
I was actually looking on the Sonovitan website the other
day and I was just looking at so several of
the testimonials and the videos up there from cases I
have treated, and it just really just put a smile
(33:24):
on my face again seeing some of these cases that
nothing else was going to work. And one case it's
not on there, that I wish was this little guy
who he was like a forty thirty five to forty
pound mixed breed dog. They had one of those horrible
stories of abuse and being thrown out of her car
and ending up in a rescue. They had to remove
(33:47):
one leg and then did surgery on the other leg,
and the owner who adopted him pulled him around in
a wagon, carried him outside because he was non ambulatory,
and so she came to me for assess men and
we ended up using Sonova tin in the back way
because both his ankle joint and his knee joint were
(34:08):
we're not in good shape. And that dog ended up
walking again, you know. And so was he a runner
in playing ball? No? But was he able to walk
himself outside, go to the bathroom and go for a
short walk with the mom? Yes, And so that was
changing for that job. Yeah, it's pretty awesome to be
able to do that, especially when surgery can't do that
(34:29):
in elbow dysplasia, especially more advanced elbow dysplasia. Surgery is
not going to help that dog in Sonova you can.
Speaker 2 (34:45):
What do you think I know that this sort of
owner or listeners may not know this, but it's a
little bit of a controversial subject right now and veterinary medicine,
and I feel like the listeners probably it's a little
bit more mainstream. What do you think about Librella?
Speaker 1 (35:00):
Ah, I do have concerns about Lobrella.
Speaker 2 (35:08):
Yeah. Librella is a monoclonal antibody, which is it's an
injection that we give to dogs that helps target a
specific pain pathway with arthritis, and it's fairly new to
the market, and there's been some speculation that maybe there's
some pretty major side effects, So we're kind of, as
a profession I would say, trying to figure out what
(35:30):
its places, if any, So I'll let you go from there.
Speaker 1 (35:34):
Yeah. Absolutely, we're still trying to figure it out for sure.
And I think a lot of listeners are familiar with
the monoclonal antibodies because of coronavirus, because of COVID, but
this one is against the nerve growth factor. And I
have listened in on some of the studies about it
showing that it works and it works well, and I
even recently at the Venue Orthopedic Society meeting, there were
(35:56):
two different presentations showing that it was better than said categories,
but their studies stopped at six months, and that bothers
me because are oftentimes our dogs need our thritits control
for much longer than six months. And what I've seen
in my own practice is kind of a wearing of
(36:18):
the benefit. I have some colleagues so have seen some
serious side effects, so they're really hesitant to use it.
Speaker 2 (36:26):
I like to.
Speaker 1 (36:28):
I like it as an option for senior animals that
maybe are in their last year or two or three.
So I would not recommend it for dogs or cats
in the single digit years. But if we're dealing with eleven, twelve, thirteen, fourteen,
fifteen year old dogs, sixteen year old dogs like dogs
that we do not take to surgery, I think it
(36:49):
has its place, but I am worried about these side
effects for sure. I am worried about long term benefit
over short term benefit.
Speaker 2 (36:58):
Yeah. Interesting, I know. I have been personally using it
and pets where it's really a life or death matter
because they have such significant arthritis that their quality of
life is is not great, and it's a matter of well,
are we going to euganize a dog or are we
going to give it lebrella and see if it helps? Right?
(37:19):
And I am hesitant, absolutely.
Speaker 1 (37:23):
Yeah, yeah, I really am. Sometimes we'll have a five
year old dog come in already on it, and I,
you know, I try and just be more objective about
what we know for sure versus what we have concerns about.
But from my at this point in time, my professional
opinion is that it should be held off in less
(37:44):
we're looking at dogs and the double digit years. For
what you're as you're saying the it's so severe that
we kind of have nothing to lose and everything to gain.
Speaker 2 (37:56):
All right, we are going to jump into our last
segment of our episode, which is Paw and Order, and
this is the segment where if you, as a board
certain tied veterinary surgeon, are going to tell us three
things that you would not recommend doing or you would
(38:17):
not do with your own pets.
Speaker 1 (38:21):
So I actually was thinking about that part. I do
think about quite a lot because I'm a worrier with
my own animals. You know, I like check them for
oral tumors on like a weekly basis, which is completely
insane because they're very rare, but of course I see them,
so I'm always checking them. So one thing that's not
specifically surgery but does go to the health of animals
(38:45):
is I actually would not use a raw diet. A
homemade diet would be fine, but I do worry about
the raw diet propensity out there and the over one
hundred and twenty different pathogens that can be in raw diets.
And there was a study that came out that showed
like either listeria or salmonilla in over fifteen percent of
(39:06):
the diets that were test I'm like, oh, that's a
scary number. So I would avoid raw diets.
Speaker 2 (39:12):
I would like to tell the listeners that we did
not talk about this beforehand, but it's going to seem
as though we did because I harp on this all
the time. Oh, do not feed raw diets, especially especially
on our kiddy cast. Right now with the bird flu outbreak,
cats are getting bird flu from eating raw poultry. So
(39:33):
that's just all the more reason not to. And of
course it can be dangerous to our pets, but also
the people, the humans that are preparing these raw diets,
if they are you know, suppressed in any way, they
can also get very sick. So I am not a
fan of raw food.
Speaker 1 (39:51):
No, nope. And when it comes to exercise, I do
not exercise my dogs. And heat and humidity and and
I don't think a lot of owners appreciate how many
dogs will actually run themselves literally to death. They will
run themselves into heat exhaustion. They just kind of think, oh, they'll,
(40:13):
you know, they'll be okay. I mean, we'll go for
a ten mint bike ride when it's eighty degrees outside,
and they absolutely will. So I do not exercise my
dogs I will do it in the morning or in
the evening, and I let them stay couch potatoes in
the middle of the day if it's hotter.
Speaker 2 (40:32):
Human I completely agree. I have a German shepherd who
will not regulate his activity. He would run himself right
into his grave if he could. And the big thing
to remember is that these pets, they don't sweat like
we do, so they regulate their body temperature through panting
(40:54):
and also their popads, which if they're on hot concrete
or asshole and makes it very difficult to do. So.
Speaker 1 (41:00):
Yeah, yeah, I live in really so I live in
a very active area. There's lots of hiking trails and
mountains people can hike. And I have a hard time
talking to people when I see their dog, like the
tongue is out, it's like an off shade. I'm like,
they're literally carrying their fur coat with them.
Speaker 2 (41:21):
Yeah, yeah, exactly exactly. And I feel like, you know,
as a owner that is not a veterinarian, you probably
you don't see dogs overheat, but we see dogs come
in from overheating and heat exhaustion, and it is life
threatening and it's a really awful thing to witness. And
(41:41):
so I couldn't agree more with that.
Speaker 1 (41:44):
In our twenty four seven clinic, in the summer, we'll
see a couple of heat exhaustions a week. So granted,
you know, again we are seeing the worst of the worst,
but we do see it a couple times a week,
and it is so preventable.
Speaker 2 (41:59):
It is. Yeah, all right, what's our last one?
Speaker 1 (42:04):
The last one we actually touched on earlier, but it
bears repeating. I would not wait in my own dog
for a complete tear of the cruciate ligment before I
would take them to surgery. I would absolutely take them
if they are showing me a rare limb lameness and
I confirm it's cruci the ligament to generational disease, I
(42:25):
am going to surgery at that time. I'm not waiting
for a complete tear. I think that's one of those
things that's out there, like, don't do surgery unless it's
a complete tear. That is, it's just wrong. It was
information I think that was out there in the eighties
and nineties and into the twenty first century when our
techniques maybe weren't quite as good as addressing it. And
(42:48):
now that the leveling technique or the TPLO it just
has such a good track record, and dogs do better
when they have less arthritis and when their meniscus is intact.
Speaker 2 (43:00):
I think that this is good for me to know
too as a general practitioner, because we will often say, hey,
why don't we just you know, give it some time
or see how it goes, And ninety nine percent of
the time they need to go to surgery, And something
that could have been done six months to a year
prior could potentially make their prognosis that much better. So
(43:21):
I think that that's really important.
Speaker 1 (43:24):
Yeah, And just like people, right, they're better off when
their muscle mass is strong, when they're young and healthy,
when they haven't been on lots of medications that aren't
always great for their liver and kidneys. I agree with
another saying I like to tell my owners and my
son is if you can avoid surgery, you probably should.
You know, a good rule to live by. But what
(43:46):
comes to the hind and lameness that's attributed to the
knees and specifically Cruisied ligament disease.
Speaker 3 (43:54):
What are we waiting for, right Like, if we know
it's a Cruisie ligament, if the dog is laying, we
take those those X rays those radiographs and you can
see the classic changes in that knee.
Speaker 1 (44:05):
What are we waiting for because it's not the Crucian ligment,
it's not going to magically heal. So you know, that's
just what I'll I'll have that conversation with owners early
about it. It is it's better for the knee, it's better
for the dog on every front to just go to
surgery when it's a partial tear.
Speaker 2 (44:24):
Yeah, And I know, I think if I had to guess,
we're not waiting, obviously it's not going to get better.
It's only going to get worse. And I think owners
are just wrapping their mind around the fact of, Okay,
this has to happen. But when you know it's best
for your dog, it just makes all the sense in
the world.
Speaker 1 (44:40):
Yeah, it's a it's a clear medical slash surgical recommendation,
and then owners have to decide what's best for them.
And that's that's okay, right. I want my owners to
feel supported no matter what they choose to do do.
But the science now is, in my opinion, it's very clear,
(45:02):
one point decision.
Speaker 2 (45:06):
Well, thank you so much for coming on. I really
appreciate your expertise. And you know for sharing some of
your experiences. You've been doing this for a long time and.
Speaker 1 (45:17):
I am the old person now in the group. I
don't know how that happened, but it's been a pleasure.
Speaker 2 (45:25):
If the listeners wanted to find you, where would they
find you? Are you were relocated?
Speaker 1 (45:31):
Yeah? So, I am the owner and operator of Portland
Venue Emergency and Specialty Care in Portland, Maine.
Speaker 2 (45:39):
Amazing. Well, thank you so much for coming on and
for all of the listeners out there, as always, please rate, review, subscribe,
let us know what you thought of today's episode. You
can find me on all the socials at Doctor Josievett
and we will see you next week
Speaker 1 (46:04):
To
You're listening to In the Vet's Office with doctor Josie Horshak.
Speaker 2 (00:16):
All right, everyone, welcome back to in the Best Office.
I am your host, doctor Josie, and we have a
very exciting episode today because we are joined with an
incredibly accomplished guest, doctor Marta Agrodnia, a highly respected veterinary
surgeon with a deep passion for advancing animal care. Whether
she's in the o R, mentoring young vests or advocating
(00:36):
for the well being of her patients, Doctor Grodnia brings skill, compassion,
and innovation to everything she does. Welcome to in the
Best Office.
Speaker 1 (00:44):
Ah, thank you so much for having me.
Speaker 2 (00:47):
We have had a couple specialists on. I've had an oncologist,
a nutritionist, an internis. But you're a first surgeon.
Speaker 1 (00:56):
Yeah, fabulous, I know.
Speaker 2 (00:58):
So we're excited to have a lot of my job,
you know, as a veterinarian is managing things medically, but
there's also a large portion that requires surgery, and some
of which I'm able to do as a general practitioner,
and then also a fairly big chunk that we ship
off to you as a board certified surgeon. Do you
(01:21):
mind explaining a little bit what the difference between me
as a general practitioner and the difference as you as
a surgeon? What that is?
Speaker 1 (01:28):
Sure?
Speaker 2 (01:29):
Sure?
Speaker 1 (01:29):
So in human medicine it's very similar. We all go
through four years of medical school and at the end
of that we're all doctors. But on the human side,
they have to go on and do some type of
residency training, be it family practice, orthopedic surgery, dermatology, cardiology, something.
(01:49):
On the veterinary side, around five percent of us after
veterinary school go on to do advanced training with internships
or residencies. So after four years of veninorary school, well,
I did additional four years of the anestesian searchicle training
to become a board certified surgeon.
Speaker 2 (02:06):
And I always tell listeners it's interesting because there isn't
a ton of regulation around it, like we can just
as general practitioners say, I'll do whatever I feel comfortable with,
and then when I feel like it's above my pay grade,
I ship it to you. So it's really it's kind
of interesting in the way that that works. I think
there needs to.
Speaker 1 (02:26):
Be flexibility, right, There needs to be flexibile in vendory
medicine to give people options.
Speaker 2 (02:31):
Absolutely, yes, well before we dive in and get to
show you a little bit more. I always start this
episode with the case of the week and we talk
about some sort of case that the listeners will find
interesting and kind of giving them a peak behind the
scenes of what we do in the trenches. And I figured,
who better to do the case than you? Oh?
Speaker 1 (02:53):
Sure, well, thank you.
Speaker 2 (02:54):
Yeah.
Speaker 1 (02:55):
I've been practicing for twenty eight years and there is
always an interesting case of the week, for sure, and
in our specialty practice, we do tend to see the
hard cases. Recently, I had a fun case as it
was one hundred and ten pound middle aged black lab
dog that came. The dog started having difficulty eating and
(03:18):
then finally stopped eating, and anybody who has levet or
retrievers note that is a huge red flag that something
is not right. And when the referral veninarian took chest
radiew grass, the dog had a very very large mass
inside its chest and the owners were initially told it
was inoperable. But the problem is that the dog could
(03:40):
not eat because his esophagus was completely squashed by this mass.
So he came to us for a full workup and
we diagnosed this dog with a type of cancer called
the thighmoma, and my experience with those or those challenging,
most of them can be removed surgically. So we went
in and did the surgery and removed a twelve pound
thy MoMA from the middle of this dog's chest. And
(04:04):
so this one hundred and ten pound dog became a
ninety eight pound dog and he was able to eat
the day after surgery. They pursued additional treatment with chemotherapy
and radiation therapy because these owners were all in and
he was still in complete remission ten months later. Because
I just got the feedback from this guy. So that
(04:24):
was pretty special to take a case that nothing else
was going to be able to help him and give
him back his quality of life.
Speaker 2 (04:31):
That's amazing. I can't imagine having a twelve pound can
you imagine?
Speaker 1 (04:36):
Yeah, And he kept eating, he kept going until that
esophagus was to squeeze shut and he couldn't get a
single drop in.
Speaker 2 (04:43):
That's so funny. You do say, like, we there are
some dogs out there when they stop eating, you know
it's bad, you know it's really bad.
Speaker 1 (04:50):
I myself have a black lab.
Speaker 2 (04:52):
I know. Yeah, And then you definitely you know they're
like our garbage disposals of utionary medicine exactly.
Speaker 1 (04:57):
They call him are vacuumquator. What's my husband called him?
Like pre rints or pre washed. When the dishwashers open,
he's right.
Speaker 2 (05:05):
There, He's like, I will help you. So, okay, I
feel like that's somewhat of a more extraordinary case. What
are the main cases that you're seeing on a daily
basis as a surgeon?
Speaker 1 (05:18):
Sure? So in our practice we do about fifty percent
orthopedicx fifty percent soft tissue, and on the orthopedic side,
the cruciate ligment disease is absolutely the most common thing
that we see day in and day out. It's very
rare for our hospital not to be doing between one
and four cruciate surgeries. And so that most common surgery
(05:40):
we do is called the TPLO or tibial plateau leveling osteotomy,
and that for.
Speaker 2 (05:45):
The listeners is for we say cruciate and it's similar
to an ACL tair in humans. We call it the
cranial cruciate ligaments. That it's essentially the same as the
ACL and human which I would have to assume that
the majority of a that they've had dogs, they're multiple dogs.
They're familiar with this because it is super duper common.
Speaker 1 (06:05):
Yeah, it's very common. As you said, the ligament functioned
as the same between humans and dogs. It prevents the
tibia from moving forward in relationship to the femur. But
the difference in humans, right, is that when we injure
our acl our cruciate ligament, it's always traumatic, and we
know if we go on arthroscopically the same day we
(06:27):
injure it, we get very set images that show us
the whole knee was healthy and just that ligament was
torn because we did something downhill, skiing or soccer, you
name the sport and it can happen. But in dogs,
it's a degenerative process to that cruciate ligament, and if
you go even the same day, owners see the lameness.
The arthroscopic images are completely different, and that ligament's been
(06:49):
degenerating over a period of weeks, months, maybe even years
before it finally starts to shred and tear and the
dog becomes lame from it.
Speaker 2 (06:58):
It's interesting because we see I see a lot of
clients where we suspect the cruciate hair, whether it's partial
or full, and clients really struggle with it because one
day the dog looks fine, yeah, and by fine I
mean like not super duper lame, and then the next
day it can be really augay and limping, and so
it's kind of like waxes and waves, and I think
people have a hard time wrapping their mind around the
(07:22):
fact that it's probably not going to get better without surgery.
Speaker 1 (07:27):
Yeah, it is a degender process. And what I explain
to owners because sometimes owners think, oh, I shouldn't let
my dog exercise because that's why they hurt their knee.
I'm like, no, No, Having strong thigh muscles is protective
of the cruciate ligament, just like in people. In fact,
in dogs, the only breathe that doesn't get crushiet ligament
disease is the greyhound because their thigh muscles are just
(07:49):
huge compared for their body weight. So we want them active,
we want them fit. It still happens in somewhere between
ten and fifteen percent of dogs, and the reason is
because they're canines. It's a species related problem. So in humans,
if you're standing straight up, the top of your tibia
bone is like a tabletop to the ground. It has
a downward slope between three and seven degrees, and the
(08:12):
wolf has been radiographed, and interestingly, their downward slope is
between nine and ten degrees. But the canine species, it
doesn't matter if you're a labrador or super mutt, because
they have a couple of those two. It's about twenty
five and a half degrees, so it's about five times
steeper than a human. So the femur is naturally falling
off the back of the tibia, and it's that cruciate
(08:33):
ligament that holds it up there, and that's why it's
so susceptible to that degenerative wear and tear break down,
so that the fibers degenerate and then the tearing starts
and eventually it will completely tear. So in those partial cases,
the evidence is becoming stronger and stronger that we should
go to surgery sooner because you maintain them the niscal
(08:54):
health because canines little doggies have miniscal carlage just like
people do, and maintains the overall cartilage health and the
me so the sooner the better, the sooner the better.
I do recommend operating on partial tears, and I don't
say that lightly because I do a lot of training
of surgeons, and I have a of my personal children
(09:16):
is actually in human medical school and he wants to
become a human surgeon. Why humans, I don't know. I
have no idea, but that's what he wants to do.
But the point being is that surgery can always make
a patient worse, so you have to be very thoughtful
about that and always look at the risks versus the benefits.
So with these partial tears, it took me a long time,
(09:39):
and I've been practicing almost thirty years to really feel
confident that we are doing our patient's a service by
recommending surgery sooner rather than later. And at this point
in time in my career, I am one hundred percent
behind taking partial tears to TPLO surgery and the evidence
supports that. In fact, just of NUO Orthopedic Society conference
(10:01):
this year, they did some really nice work showing that
the longer animal is lame, it actually does affect the prognosis.
Speaker 2 (10:10):
Yeah, I mean that that definitely makes sense. And having
had a dog that's had two TPLOs, one on either side,
and I will say to listeners, and I'm sure you
will concur that if your pet here is one apl
or CCL on one side, they are very likely to
hear the other on the other side. So I just
kind of pep Boner.
Speaker 1 (10:30):
For that was true. It's true. Really, it depends upon
their age. So when they are seven years or younger,
it's more likely than not that the other side is
going to go. And why one side precedes the other,
we don't know. It's just it's just always has But
it's true when they're younger this seven years, but it's
also good to know when they're eight years or older.
(10:53):
It's actually like flip so that it's somewhere around seventy
seventy five percent likelihood if they're under seven, and it's
about only twenty five percent or so if they're eight
or older. So if it is an older animal, you
can kind of take a little bit of a side.
Depends on how you view that glass of water, right,
but it is if your dog is eight years or older,
(11:15):
the chances are you'll only have to do one side.
Speaker 2 (11:19):
That is interesting. Yeah, I guess it depends on how
you look at the glass of water, half full or
half half empty.
Speaker 1 (11:25):
Yeah, But and it's important to know that that is
an age difference that we appreciate now that we didn't
always appreciate, and.
Speaker 2 (11:34):
I do have a lot of owners say, I feel
like we've really gone down this rabbit hole of PPLOs.
But this is important because I know it's a lot
of what's so common, right and so common. I have
a lot of owners sayed to me, oh, I'm so
worried about the postop experience, twelve weeks of postop recovery
and experiencing it myself. Of course, twelve weeks is a
long time, but they do remarkably well. I find that
(11:56):
the majority, the overwhelming majority of my patients that do
have eplos go on to have a great prognosis.
Speaker 1 (12:03):
Yeah, and it's helpful. I can speak to it as
well from the client experience side, having two dogs that
had four knees done. So I've done over two thousand
TPLOs as a surgeon, and I've lived through the recovery
four times myself personally. And it's true about ninety five
(12:24):
percent of owners feel their dogs get back to ninety
five percent or better. But there's there's reasons why we
don't have one hundred percent. And that's also where we
talk about arthritis and how we treat arthritis, and I.
Speaker 2 (12:37):
Think you know a big portion of that too is
you know, setting expectations that your pet has injury in
its joint space and that does predispose it to arthritis?
Are there? I guess we should probably jump into arthritis
in general.
Speaker 1 (12:53):
That's what a great segue.
Speaker 2 (12:55):
I am sure that you probably see a lot of that.
How well, I guess for the listeners, what are some
signs that they should be looking for at home that
their dog may have arthritis? And if they're seeing that,
what do you recommend that they do?
Speaker 1 (13:09):
Sure? Well, if their dog has a lameness, I do
recommend going to your veterinarian, you know, sooner rather than later.
And that doesn't mean the first day, you know, we
can all take a bad step and maybe the next
day we're fine. But if you're I do tell owners
to trust their gut. They know their dogs far better
than we do. They're very attuned to their dogs. If
(13:29):
you're seeing that, lamus, see your veterinarian. The first most
important step is always conservative management. Is your dog in
a good body weight? Are they reasonably fit? You know,
are they exercising on a regular basis? And once you
have that conservative management, then you can start looking at
medical management and medical management could be anything from the
(13:49):
non cridle anti inflammatory drugs, which are the scientifically proven
category to help with arthritis. There's other supplemental categories that
the science is a little bit softer, but still good
to know about, things like the glucosamine conjointans, the antioxidants.
You've got a pain control category like gaba, penton, a mantadine, tramadol.
(14:12):
Those might be appropriate more advanced cases. And then if
there's really a joint or a couple joints that are
the problem joints, you can start considering joint injections.
Speaker 2 (14:24):
There's one join injection that I have learned about fairly recently,
and there's actually a veterinarian I go to a surgeon
in Cincinnati that's using it pretty frequently. Have you heard
of sonovatin?
Speaker 1 (14:37):
I have. In fact, I've been using snosin for I
think five years now.
Speaker 2 (14:42):
Okay, have you been using it for a while? Do
you mind? I think this is a really interesting option
out there for clients, and I don't know that it's
as well known as you know putting them on remadil
or putting them on gabage London, So do you mind
just driving them. Just a little bit about what exactly
it is and how it works.
Speaker 1 (15:02):
Sure, Sonovatin is a medical radiotherapeutic. So this radioisotope, it's
technically known as ten one point seventeen M. It is
put directly into the joint. So what's great about it
is that it works at the source and its mechanism
of action is that it's taken up by macrifages and
(15:22):
sonovo sites and it then destroys those cells. So instead
of the insid category of medications that stop the inflammatory
cascade kind of midway through, like they're enzyme inhibitors, the
sonovatonoa destroys the cells that create those inflammatory mediators, and
(15:42):
so it's really hitting inflammation at the source. So it
just does a great job at stopping that inflammatory cascade,
and so it does take some time. But again, because
the mechanism of action is local, you don't have to
worry about any side effects with the liver or the
kidneys or the GI system. It's about five percent and
the dogs will have gastrointestinal side effects to the un
(16:03):
said category, you don't have to worry about forgetting, Like
I'm a doggy owner, I've got three dogs, and even
trying to remember my own dogs medication with my busy
life with kids and working is really hard. So I
don't have to worry about me forgetting the medications. I
don't have to worry about checking blood work. I don't
have to worry about any systemic side effects that they're
(16:24):
just not there. So once the medication is delivered, then
it can take anywhere from one to eight weeks to
start working because it takes time to kill off those
macrifages and snovaa sites and then all those cytokinds to degrade.
And it's also nice because this is a disease modifying device,
so it can actually change the fluid there that helps
(16:46):
keep the cardless healthy. So I'm really excited to see
what snovodan is doing now and what we're going to
learn more about it in the future.
Speaker 2 (17:05):
What would be a case like, are we talking a
dog that comes in with elbow arthritis or me arthritis?
What does that look like When you're like, yes, and
would you great with this medication?
Speaker 1 (17:15):
Yeah?
Speaker 2 (17:16):
Or advice? I should say I, well, yeah, exactly.
Speaker 1 (17:20):
It is FT approved as a device for K nine elbows,
but because of regulations are state by state, I'm allowed
to place it in any sonovial joint in cats or dogs.
So that's fantastic because although elbows are the most common,
I've placed it in a lot of knees and I've
placed it in just about any joint that I can
(17:42):
get that needle into. And you seem really good effects
from it.
Speaker 2 (17:47):
Have you done it? And I'll fay risks to keep
it simple, but the carpet, yes, okay. I have quite
a few patients with Risks arthritis, so that's interesting to hear.
And when you're doing it in me, there these of
patients that have had appreciate disease and then have had
PPOs and afterwards you're giving the induction.
Speaker 1 (18:10):
For myself. Yes, like, those are the cases I'm seeing
and I'm doing when it comes to stifles or knees,
and I have been absolutely thrilled with some cases. I
have one case that had bilateral TTAS, which is a
similar type of surgery to the TPO, similar but different,
and the surgery was done elsewhere. It was done in
New York, and the owner moved to Maine and the
(18:33):
dog remained mediocre. She came to me a year or
so after the surgeries had been done. I started working
with her making sure like did your dog suffer meniscal
injury after the surgery. We worked through some other types
of joint injections, and then back in twenty twenty when
(18:53):
I started using this, we put Shamus on the list
and said all right, let's try the Sonovatan for him.
And she contacted me two months after the device that
Snowton was placed in her dog's knees and she's like,
he's running up the mountain again. She's like, he hasn't
been running in front of me for over three years now,
(19:14):
He's running in front of me. Like she was just
absolutely ecstatic. So I think about some of these cases
and the recalcitrant cinevitis or inflammation that stays in that
joint after cruciate surgery that oral medications can't always resolve,
and I find synova tin resolves it. So I've seen
really good success following some of those TPLO cases that
(19:34):
just don't get to that ninety five hundred percent.
Speaker 2 (19:37):
I think that's really such a great option for the
listeners as owners to know that, yes, there are going
to be cases where your pet far and wide really
needs to have a proceedure done to get them the
best result possible, but then even post off if they
don't reach one hundred percent. We do have these joint injections,
or in some cases they may you may elect not
(19:59):
to do so at all and just do the joint injection.
So her pet does have really bad elbows. Writers, I'm
sure there's some cases where you would want to do
surgery beforehand, but you could just inject a joint and
they could have a great It sounds like a great recovery.
Speaker 1 (20:14):
I'm they respond, I've been using Snowton for five years
and I've only gotten happier and happier with it. My
own personal dog a full disclosure. After he had his
bilateral TPLOs and he was a really big boy. He
was running during the summer. He had his like a
TPO in December, a TPO in February. So he's out
(20:35):
running in the summer with his brothers outside and he's
laying in the front. It's like, you've got to be
kidding me, right, Like I'm the classic owner, Like no,
I just got through this TPLO recovery, Like what's going on?
And it was his elbows. So I was like, nope,
no more surgery for you. We went right to Sonovatan
and I was fortunate he was sound for a full
(20:56):
eighteen months before I had to repeat the injection. But
it was so worth not having to go back and
do another surgery for him, yeah.
Speaker 2 (21:06):
Or give him daily medications every single day, which I
know that snowakan is not inextensive. I think it's you know,
a couple of thousand dollars, but if you think about
medicating a very large dog for an entire eighteen months,
you're probably looking at no longer.
Speaker 1 (21:20):
Yeah. Absolutely, in the blood work you should be checking
in my own dog. Again, he's a big boy. He
was one who he's a rescue and he gets diary
if you look at him cross eyed. So for him
and SAIDs are just not a good option. Now it's
like I need to save my marriage and I cannot
have the dock having diary in the house.
Speaker 2 (21:39):
Yeah, I feel that to my core. I could get that.
Aside from all of the orthopedics up, what are some
of the soft tissue procedures that you're doing as a surgeon.
Speaker 1 (21:50):
Sure, well, I personally love a lot of oncologic surgery.
I love working with cancers and providing owner options. So
it might be mass sells tumors that grow, it might
be soft tissue sarcomas. Another really amazing surgery I had
just a couple of years ago they stayed with me
(22:10):
was a very very large Great Dane. It was like
one hundred and seventy pound Great Dane that had the
owner's just noticed it was getting bloated, and so it
got worked up by our internal medicine team. They said,
there's a large tumor in this dog. I don't know
what it is, but you know, we need to do
(22:32):
something about it because it was all this fluid. The
reason why the dog was looking bloated was because of
free fluid in the dog's belly. So I ended up
taking a football size You got to really picture a
football size, like a twenty five centimeter size adrenal tumor
from this dog's right side. And in addition to that,
(22:52):
the reason why the dog lost four leaders of fluid
in its belly was because it also had a large clot.
It's been a cava. So I then removed what was
about the size of an orange clot out of its
being a cava, and that dog was actually cured from
its tumor. So it is. I love doing oncologic surgery.
(23:14):
I love providing owners options in helping dogs, especially I said,
when really nothing else is going to do.
Speaker 2 (23:21):
It, you are braveful. Do you ever get nervous? Bring
for theaters or are you cool the cucumber?
Speaker 1 (23:30):
I am better as I've gotten older at managing those
emotions because every patient life means so much to us.
And you know, I was trained again, I was trained
back in the nineties, and you're supposed to like, never
tell someone what you do if it was your animal,
and I feel like I just don't agree with that
(23:51):
philosophy because what owners really want to know is that
you care and would you do this if it were
your own animal, And when they come into my sphere,
I feel very maternal about them, and so I do
have to work on that separation when I'm in the
barbum to be more of a problem solver, But that
animal feels like it's my animal, so it's hard for
(24:14):
me to completely separate that.
Speaker 2 (24:17):
I completely understand that. I think owners. I can't tell
you how many times a week I haven't owners say
what would you do with it? With your pets? And
we do have to be careful with that, but I
under percent do love their pets similar to how I
would love my own. I'd take that, I don't take
that lightly. And so I understand what you're saying completely.
Speaker 1 (24:36):
Exactly, because also I've had I'm on dogs number like six,
seven and eight right now, I've had eight different dogs
over the course of my lifetime, and they're not all
the same, and so the choices I might make for
one might not be the same. And I also acknowledge
that sometimes I'm sure I know what I'm going to
do given a certain set of circumstances, and then I'm
(24:56):
there and I make a different choice, and that's okay.
I tell me all the time, I want you to
feel supported no matter what you choose to do. And again,
when they asked that question, what they really want to
know is do you feel that there's a right way
or wrong way? And sometimes there's not, you know, sometimes
they say there are different options. It's not a right
or wrong and it's absolutly okay to choose not to
(25:18):
do something. Part of our jobs is experience, is to
give them information so that they make the decision that's
best for them. Their animal their family, their set of circumstances.
Speaker 2 (25:29):
Yeah, I completely agree. I think a lot of our
role is to be given the information, like you said,
and then whatever is best for them, help be their
support system and their experts that's going to help guide
them along the way. So have you ever done surgery
on any exotic or view animals or primarily dogs and cats?
Speaker 1 (25:51):
Yeah? I primarily just do dog and cats for sure.
I have had the opportunity to do some exotics over
the years, some ferrets or bunnies. One of my favorite
cases was a capuchin monkey because this little guy had
a cancer that was really bothering him. And this was
a service monkey, so his owner was a quadriplegic. So
(26:12):
that's a whole other level of responsibility, right. So I
did work with people familiar in the zoo setting to
help us with the anesthesia, because they're more like humans
than anything else. But that was that was actually pretty
amazing to just be able to interact with that little guy.
Speaker 2 (26:27):
I'm sorry, what kind of procedure did you do on him?
Speaker 1 (26:30):
So he got a cancer that was growing on his
ARMM and so I had to do a soft tissue
surgery to remove it, and then a little bit of
reconstruction to make sure that the skin got backward needed
to be because it's very different skin than cats and dogs.
Speaker 2 (26:48):
Is it? And what is it? More thin?
Speaker 1 (26:51):
It was more thin, And because the blood supply is
like a human right, So in humans, our blood supply
comes up directly from the tissues underneath to our skin.
But in dogs, they have much thicker skin, and their
blood supply comes up through a single major vein and artery,
So these vessels supply a whole segment of skin. So
(27:14):
the blood supply system is honest, it's just completely different
between the two. So I did I had to do
some research to make sure that I was I would
not know that, Oh, yeah, it's completely different. That's yeah.
I can explain a lot. I feel like I'm going
to go down a rabbit hole here if I get
too far, because I start getting gritty of things really interesting.
Speaker 2 (27:34):
And I'm assuming it was intubating the monkey similar. I mean,
I guess, just like intubating any other mammal.
Speaker 1 (27:42):
So the monkey. I did wonder if I should intubate
like you see on the human TV dramas where they're
behind the head and they do some type of intibation,
but because I'm a veterinarian and I'm so used to
intubating looking at the face that that's how I intubated
this little guy.
Speaker 2 (28:01):
And of all the procedures that you do, is there
one that you find to be the most challenging or
you see it on your schedule and you're like, oh,
I wish I didn't have to do this.
Speaker 1 (28:14):
I think with surgurgery, I don't think there's one that
I wish I didn't have to do. I will say
there's a couple that because they can throw you curveballs
or more stressful than other cases, like the adren electomies are,
they always have the potential to throw your curveball. You know,
(28:36):
there's no such thing as a straightforward a dream electomy.
Some of those shunts, so if dog or kitty cats
have vessels in the abdomen that are bypassing the liver,
so what we call a shunt vessel, those are also
challenging because the surgery itself can go absolutely beautifully, but
(28:57):
yet there can still be a post operative complication that
can even be life threatening.
Speaker 2 (29:03):
When I ask you this about oh gosh, I wish
I didn't see that on my schedule. I think back
to all of the general practitioners I've worked with, and
I think something that listeners don't know is that a
lot of GPS will tell you, oh, yeah, I'm fine
doing a neuter. I'm find doing a mask and reval.
I really don't like to do big dog spas, and
I don't know that the average owner recognizes how big
(29:26):
of a procedure it is. And I'm certainly not saying
don't do it, because I highly recommend it, but it's
like a pretty invasive surgery that requires quite a bit
of skill. So I always like to point that out
to my owner.
Speaker 1 (29:39):
Yeah, I do think that the veterinar profession has sent
itself at a service by minimizing the space and neuters,
because these are especially the spas, are abdominal procedures. But
even with neuters, unfortunately I see life threatening complications and
(29:59):
you will, and they are significant procedures. It's not just
the anestiegia, it's the surgery itself. So I think I
agree with you, like owners really do need to be
made aware that this is something but significant. We don't
take it lightly. We want to do it with the
utmost professionalism and the bigger the dog, the harder it is.
(30:23):
So I agree with you that it should be treated
with the significance it deserves, and.
Speaker 2 (30:29):
I think we're starting to go more that way. I
just you know, when owners get the treatment plan or
the estimate for the procedure, I think they're like, wow,
it's just a say how could it be so expensive?
And I'm like, well, just to spay is a fairly
complicated and requires a lot of skilled procedure.
Speaker 1 (30:45):
So I always to think about the IVY catheter, the
antesesian medications, the fluids, the monitoring, the instrumentation, the time
it takes. Because a large dog spae is actually a
major surgery. We also offer a laparoscopics bade Our clinic,
which is actually a lot of fun. It's a nice
(31:07):
option to have, but it's still a major ordeal because
the anesthesia involved, and that is more critical than when
you're opening the appdomen. So I absolutely agree with you.
And you know, for another thing to relate to the
GP practice is whenever I have a neighbor that talks
to me about, hey, this this practice does a dentistry
(31:29):
you know for eight hundred and this other practice quoted
me for fourteen hundred. I'm like, go to the fourteen hundred.
I'm like, you're not comparing apples to apples. I promise
you the fourteen hundred will have better monitoring. They'll have
technicians that are trained to do it, they'll have money
heating pad, they'll monitor them post you know, post dentistry.
Like that's just another one, right that you really want
(31:49):
to do it well, not just do it inexpensively.
Speaker 2 (31:53):
Exactly. It's not worth shopping around when it comes to
your pet, potentially to their life, so paying is worth it. Yeah, yeah, Okay,
anything else that you think we're missing with arthritis or
cruciate disease, anything you want to point out that you
see on a daily basis, that you recommend or that
(32:16):
we should think about.
Speaker 1 (32:17):
I think the big points yeah, I think the big
points with cruciate disease is sooner is better than later.
You do want to get them before they have advanced
cartilage damage and before the meniscus is damaged, if possible.
I think the TPLO is a great surgery. As I said,
I've done it a couple thousand times for arthritis of
(32:39):
all kinds, be it elbows or knees, the sonovatant is
a wonderful option. It provides really long lasting pain relief,
and although it works best in the earlier stages, it
can help keep that cartilage healthier longer, which is fantastic.
It also works in advance cases, and most of the
(33:01):
cases I'm still treating our advanced because these are the
owners that are turning over every stone possible and it's
still working seventy five plus percent of the time. And
I was actually looking on the Sonovitan website the other
day and I was just looking at so several of
the testimonials and the videos up there from cases I
have treated, and it just really just put a smile
(33:24):
on my face again seeing some of these cases that
nothing else was going to work. And one case it's
not on there, that I wish was this little guy
who he was like a forty thirty five to forty
pound mixed breed dog. They had one of those horrible
stories of abuse and being thrown out of her car
and ending up in a rescue. They had to remove
(33:47):
one leg and then did surgery on the other leg,
and the owner who adopted him pulled him around in
a wagon, carried him outside because he was non ambulatory,
and so she came to me for assess men and
we ended up using Sonova tin in the back way
because both his ankle joint and his knee joint were
(34:08):
we're not in good shape. And that dog ended up
walking again, you know. And so was he a runner
in playing ball? No? But was he able to walk
himself outside, go to the bathroom and go for a
short walk with the mom? Yes, And so that was
changing for that job. Yeah, it's pretty awesome to be
able to do that, especially when surgery can't do that
(34:29):
in elbow dysplasia, especially more advanced elbow dysplasia. Surgery is
not going to help that dog in Sonova you can.
Speaker 2 (34:45):
What do you think I know that this sort of
owner or listeners may not know this, but it's a
little bit of a controversial subject right now and veterinary medicine,
and I feel like the listeners probably it's a little
bit more mainstream. What do you think about Librella?
Speaker 1 (35:00):
Ah, I do have concerns about Lobrella.
Speaker 2 (35:08):
Yeah. Librella is a monoclonal antibody, which is it's an
injection that we give to dogs that helps target a
specific pain pathway with arthritis, and it's fairly new to
the market, and there's been some speculation that maybe there's
some pretty major side effects, So we're kind of, as
a profession I would say, trying to figure out what
(35:30):
its places, if any, So I'll let you go from there.
Speaker 1 (35:34):
Yeah. Absolutely, we're still trying to figure it out for sure.
And I think a lot of listeners are familiar with
the monoclonal antibodies because of coronavirus, because of COVID, but
this one is against the nerve growth factor. And I
have listened in on some of the studies about it
showing that it works and it works well, and I
even recently at the Venue Orthopedic Society meeting, there were
(35:56):
two different presentations showing that it was better than said categories,
but their studies stopped at six months, and that bothers
me because are oftentimes our dogs need our thritits control
for much longer than six months. And what I've seen
in my own practice is kind of a wearing of
(36:18):
the benefit. I have some colleagues so have seen some
serious side effects, so they're really hesitant to use it.
Speaker 2 (36:26):
I like to.
Speaker 1 (36:28):
I like it as an option for senior animals that
maybe are in their last year or two or three.
So I would not recommend it for dogs or cats
in the single digit years. But if we're dealing with eleven, twelve, thirteen, fourteen,
fifteen year old dogs, sixteen year old dogs like dogs
that we do not take to surgery, I think it
(36:49):
has its place, but I am worried about these side
effects for sure. I am worried about long term benefit
over short term benefit.
Speaker 2 (36:58):
Yeah. Interesting, I know. I have been personally using it
and pets where it's really a life or death matter
because they have such significant arthritis that their quality of
life is is not great, and it's a matter of well,
are we going to euganize a dog or are we
going to give it lebrella and see if it helps? Right?
(37:19):
And I am hesitant, absolutely.
Speaker 1 (37:23):
Yeah, yeah, I really am. Sometimes we'll have a five
year old dog come in already on it, and I,
you know, I try and just be more objective about
what we know for sure versus what we have concerns about.
But from my at this point in time, my professional
opinion is that it should be held off in less
(37:44):
we're looking at dogs and the double digit years. For
what you're as you're saying the it's so severe that
we kind of have nothing to lose and everything to gain.
Speaker 2 (37:56):
All right, we are going to jump into our last
segment of our episode, which is Paw and Order, and
this is the segment where if you, as a board
certain tied veterinary surgeon, are going to tell us three
things that you would not recommend doing or you would
(38:17):
not do with your own pets.
Speaker 1 (38:21):
So I actually was thinking about that part. I do
think about quite a lot because I'm a worrier with
my own animals. You know, I like check them for
oral tumors on like a weekly basis, which is completely
insane because they're very rare, but of course I see them,
so I'm always checking them. So one thing that's not
specifically surgery but does go to the health of animals
(38:45):
is I actually would not use a raw diet. A
homemade diet would be fine, but I do worry about
the raw diet propensity out there and the over one
hundred and twenty different pathogens that can be in raw diets.
And there was a study that came out that showed
like either listeria or salmonilla in over fifteen percent of
(39:06):
the diets that were test I'm like, oh, that's a
scary number. So I would avoid raw diets.
Speaker 2 (39:12):
I would like to tell the listeners that we did
not talk about this beforehand, but it's going to seem
as though we did because I harp on this all
the time. Oh, do not feed raw diets, especially especially
on our kiddy cast. Right now with the bird flu outbreak,
cats are getting bird flu from eating raw poultry. So
(39:33):
that's just all the more reason not to. And of
course it can be dangerous to our pets, but also
the people, the humans that are preparing these raw diets,
if they are you know, suppressed in any way, they
can also get very sick. So I am not a
fan of raw food.
Speaker 1 (39:51):
No, nope. And when it comes to exercise, I do
not exercise my dogs. And heat and humidity and and
I don't think a lot of owners appreciate how many
dogs will actually run themselves literally to death. They will
run themselves into heat exhaustion. They just kind of think, oh, they'll,
(40:13):
you know, they'll be okay. I mean, we'll go for
a ten mint bike ride when it's eighty degrees outside,
and they absolutely will. So I do not exercise my
dogs I will do it in the morning or in
the evening, and I let them stay couch potatoes in
the middle of the day if it's hotter.
Speaker 2 (40:32):
Human I completely agree. I have a German shepherd who
will not regulate his activity. He would run himself right
into his grave if he could. And the big thing
to remember is that these pets, they don't sweat like
we do, so they regulate their body temperature through panting
(40:54):
and also their popads, which if they're on hot concrete
or asshole and makes it very difficult to do. So.
Speaker 1 (41:00):
Yeah, yeah, I live in really so I live in
a very active area. There's lots of hiking trails and
mountains people can hike. And I have a hard time
talking to people when I see their dog, like the
tongue is out, it's like an off shade. I'm like,
they're literally carrying their fur coat with them.
Speaker 2 (41:21):
Yeah, yeah, exactly exactly. And I feel like, you know,
as a owner that is not a veterinarian, you probably
you don't see dogs overheat, but we see dogs come
in from overheating and heat exhaustion, and it is life
threatening and it's a really awful thing to witness. And
(41:41):
so I couldn't agree more with that.
Speaker 1 (41:44):
In our twenty four seven clinic, in the summer, we'll
see a couple of heat exhaustions a week. So granted,
you know, again we are seeing the worst of the worst,
but we do see it a couple times a week,
and it is so preventable.
Speaker 2 (41:59):
It is. Yeah, all right, what's our last one?
Speaker 1 (42:04):
The last one we actually touched on earlier, but it
bears repeating. I would not wait in my own dog
for a complete tear of the cruciate ligment before I
would take them to surgery. I would absolutely take them
if they are showing me a rare limb lameness and
I confirm it's cruci the ligament to generational disease, I
(42:25):
am going to surgery at that time. I'm not waiting
for a complete tear. I think that's one of those
things that's out there, like, don't do surgery unless it's
a complete tear. That is, it's just wrong. It was
information I think that was out there in the eighties
and nineties and into the twenty first century when our
techniques maybe weren't quite as good as addressing it. And
(42:48):
now that the leveling technique or the TPLO it just
has such a good track record, and dogs do better
when they have less arthritis and when their meniscus is intact.
Speaker 2 (43:00):
I think that this is good for me to know
too as a general practitioner, because we will often say, hey,
why don't we just you know, give it some time
or see how it goes, And ninety nine percent of
the time they need to go to surgery, And something
that could have been done six months to a year
prior could potentially make their prognosis that much better. So
(43:21):
I think that that's really important.
Speaker 1 (43:24):
Yeah, And just like people, right, they're better off when
their muscle mass is strong, when they're young and healthy,
when they haven't been on lots of medications that aren't
always great for their liver and kidneys. I agree with
another saying I like to tell my owners and my
son is if you can avoid surgery, you probably should.
You know, a good rule to live by. But what
(43:46):
comes to the hind and lameness that's attributed to the
knees and specifically Cruisied ligament disease.
Speaker 3 (43:54):
What are we waiting for, right Like, if we know
it's a Cruisie ligament, if the dog is laying, we
take those those X rays those radiographs and you can
see the classic changes in that knee.
Speaker 1 (44:05):
What are we waiting for because it's not the Crucian ligment,
it's not going to magically heal. So you know, that's
just what I'll I'll have that conversation with owners early
about it. It is it's better for the knee, it's better
for the dog on every front to just go to
surgery when it's a partial tear.
Speaker 2 (44:24):
Yeah, And I know, I think if I had to guess,
we're not waiting, obviously it's not going to get better.
It's only going to get worse. And I think owners
are just wrapping their mind around the fact of, Okay,
this has to happen. But when you know it's best
for your dog, it just makes all the sense in
the world.
Speaker 1 (44:40):
Yeah, it's a it's a clear medical slash surgical recommendation,
and then owners have to decide what's best for them.
And that's that's okay, right. I want my owners to
feel supported no matter what they choose to do do.
But the science now is, in my opinion, it's very clear,
(45:02):
one point decision.
Speaker 2 (45:06):
Well, thank you so much for coming on. I really
appreciate your expertise. And you know for sharing some of
your experiences. You've been doing this for a long time and.
Speaker 1 (45:17):
I am the old person now in the group. I
don't know how that happened, but it's been a pleasure.
Speaker 2 (45:25):
If the listeners wanted to find you, where would they
find you? Are you were relocated?
Speaker 1 (45:31):
Yeah? So, I am the owner and operator of Portland
Venue Emergency and Specialty Care in Portland, Maine.
Speaker 2 (45:39):
Amazing. Well, thank you so much for coming on and
for all of the listeners out there, as always, please rate, review, subscribe,
let us know what you thought of today's episode. You
can find me on all the socials at Doctor Josievett
and we will see you next week
Speaker 1 (46:04):
To
Host
Josie Horchak
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