Against the backdrop of autumn in the western Catskills – a riotous clashing of cornflower blue skies and sulfur-yellow maple leaves showing off – I drove the bendy-pawed puppy and her striped chaperone across three upstate New York counties to the Veterinary Specialties clinic.
When I adopted Bindi, I knew at some point I’d be faced with decisions regarding her deformity. Watching her race around our home turf, I felt increasingly hopeful. She uses the paw well and at times even appears to run without a limp! I think that’s because she’s such a blur, I can’t pick out any individual limb. She gets zoomies daily. Her coat glows. She’s gaining weight steadily and yet looks trim – even a bit underweight to my Jewish Mama eyes. She’s definitely a happy pup actively learning about her new life here on the mountain.
But what about that paw? Here’s the most concise report I can give based on an orthopedic surgeon’s review of her file (including x rays and report from the University of Tennessee) and clinical exam:
- The cause of the floppy paw is a bone deformity. Her radial carpal bone (it’s a rectangular-ish shaped bone that is in between the radius and the tiny bones of the wrist) is malformed. About half of it is missing. While the vet couldn’t say for certain, she believes Bendy Bindi was born this way. The missing half of the bone accounts for the odd sideways placement of the paw and the gait abnormalities.
- There is nothing to be done with that bone and that joint. It is, as the vet explained, a lost cause. In my terminology, her wrist is utterly and hopelessly fucked.
- No, a brace, boot, splint, or any other mechanical device to “help straighten that thing out” is not recommended. No brace. No cast. No splint. Yes, I specifically asked. No, it is not recommended. If I sound a little testy it’s because only about eleventy thousand of you have suggested it and I get it. It makes perfect mechanical sense. It looks like it should help. But a creative and problem-solving brain and a couple google searches does not equal a veterinary orthopedic specialty and it’s the vet’s opinion I’m giving creedence to. Tom suggested a brace to, and I snapped at him. I wish it were mechanical and simple. It isn’t.
- Two surgical options were discussed. The first would not be considered until Bindi’s growth plates close. It was described as a fusion (ok, the technical term is arthrodesis, but I am able to remember and spell fusion). All the cartilage in the wrist would be removed and a bone graft from the shoulder would be used to help the joint fuse. Plates and screws from the toe to above the wrist would be used to hold the fusing joint in place. The whole shebang can be summed up as expensive, invasive, and risky. The recovery would involve a long period of crate rest – many months. The prognosis is not fantastic. It might work; the joint might fuse. Apparently sometimes it just plain doesn’t take. Infection is a huge risk. I described my lifestyle and the four other dogs in the home and admitted to the vet: it’s not suburbia here. We share our home with raccoons, bears, foxes, porcupines etc… and all their poop. Keeping Bindi and her bedding etc clean – post op recovery clean – would be a daunting task. Keeping her quiet would be a challenge. And the risks seem to work against this being a smart move.
- The only other option is to amputate the leg – the whole leg including the scapula. No prosthesis recommended. The procedure is less invasive than the arthrodesis, but still plenty invasive. Recovery is typically two weeks. The risks are infinitely less. I know most dogs recover well from amputations and continue on as before with minimal drama. The surgery is typically harder on us humans than it is on the dog. And it’s about half the price.
- Arthrodesis would have to wait til she’s fully grown. The amputation could be scheduled at any time. Her age is not a contraindication for that procedure.
- Deciding to amputate is a huge decision for me. The vet framed it up as “help versus hindrance” – when the balance of that tips to the hindrance side, we consider the surgery. As long as having the leg there is more of a help to her than a problem, it stays.
- What are the risks of doing nothing? At this point pretty minimal. As a puppy, arthritis isn’t a huge concern. At some point, all the vets agree, her toes joints and her elbow joint will be impacted by this issue and she will have chronic pain. How bad and when? Unknown. Could she be a refugee from the odds and never develop issues and live out her entire life in relative comfort? Maybe. Best guess is that she is a German Shepherd mix and GSDs are notorious for elbow dysplasia anyway.
So, at this point, I’m left with a bad prognosis and unappealing options. And a happy puppy. The good news is that I don’t have to do anything quickly and she is not in pain now. The vet remarked that her bad front leg is well muscled despite the wrist issue. Her body condition was noted as excellent. The vet supported allowing her to be as active as she wanted to be, with zero restrictions. She can hike, swim, run etc. as much as she wants to. The key is that I don’t push her, but allow her to choose her activity level and monitor for signs of pain or exhaustion.
Initially I was really upset. I felt like crying and yelling at the incredibly sweet vet “No, you may NOT cut my puppy’s leg off.” But after taking a look at my emotional reaction I realized that a big part of that emo meltdown had to do with expectations. I had hoped and perhaps even expected that the orthopedist was going to describe a nice little wrist surgery that, while perhaps expensive AF, would solve the problem neatly and forever. In other words, I was dreaming. The consult brought me back down to earth and I’m sobering up and adjusting to the situation. The joint is a lost cause. All solutions are end stage solutions and involve risk, expense, and significant adjustment.
But it’s autumn in the Catskills. And autumn despite its beauty is all about death, letting go, dropping what won’t serve you through the coming winter. And surviving until spring. My plan is to do nothing until Bindi has stopped growing and then reassess. Miracles are not outlawed. And she is using that chicken wing well for now. I’ll watch and wait and breathe and stop crying over lost causes. And now I have to stop writing and go see what she has in her mouth.