ACL (CCL) - TPLO Surgery

[wildewillie89]

Looks like one of my dogs has gone and done a knee (ACL).  Basically the only options available are the TPLO surgery (50kg active dog) or, well, nothing. The issue is my province vets cannot perform that surgery, and from what 3 different clinics have said there are not many places that can do it in the country. One of the vets graduated from Kasetsart University and said he knows they do the surgery on medium sized dogs and estimates 60,000 baht 'IF' they can do it for my dog. That is a good 5 hour drive away.

I know a long shot, but does anyone know if Khon Kaen University performs TPLO surgery? Have called them but they were pretty useless on the phone (as were Kasetsart) - just said we cannot say anything until you bring the dog in. Don't particularly want to drive a long length of time with a dog and his crook knee only to be told we cannot do anything (but I may not have a choice). 

He can live with conservative management (turmeric, massage, limited walks). Initially he was in quite a bit of pain, but with management he is only really sore after sleeping or standing for too long now. We have confined him in a 5mx4m grassed cage with a smaller 1.2x1.2m cage included within. He can still walk, still puts weight on the bad knee if needs to pee, kicks the ground after peeing, stands on his hind legs etc. The main problem is the other knee obviously has a 50% chance of going now. Which would only leave a dog wheelchair as an option so want to at least stabilise one knee if possible. 
 

Edited November 1, 2018 by wildewillie89

[dick dasterdly]

I sympathise as I went through something similar when one of my dogs came down with bladder cancer (as I've just mentioned on another thread).

 

Palliative treatment from the vet I use, or take him to Hua Hin or Bangkok to see if the specialist there could operate further or thought radiotherapy treatment would help ☹️.

 

I hope you can find the answers you need - particularly as you are always so helpful on this sub-forum with problems faced by others.

 

Edit - Please keep us updated.

Edited November 6, 2018 by dick dasterdly

[Sheryl]

Afraid I don't know re KK.

Of all the vet hospitals in Thailand Chulalongkorn seems to have the highest capacity followed by Kasetsart. So if you want to go where the odds are greatest of getting treatment I'd say Chula.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[Sheryl]

Afraid I don't know re KK.

Of all the vet hospitals in Thailand Chulalongkorn seems to have the highest capacity followed by Kasetsart. So if you want to go where the odds are greatest of getting treatment I'd say Chula.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[wildewillie89]

The good news is that we called Khon Kaen again and this time demanded the staff put a vet on the phone. The vet said they can do the surgery for 25-30k but obviously need to make their own diagnosis first. They also said they would need to double check if they can import the necessary equipment due to size. 

The biggest issue I have is Western vets who do thousands of these surgeries (due to things like health insurance, higher salaries etc), have a 90% success rate. The success rate of this surgery depends on how experienced the vet is at the surgery. So in a place like Thailand where surgery is 4-5 months salary for many people I wonder how experienced the vet will be. Super invasive surgery that requires cutting/breaking the tibia bone, re-positioning it so the tip of it is levelled rather than sloped (like a human) and then stabilising it with plates and screws. The part they cut is also weight baring which just adds to the possible complications if it isn't done correctly. 

The flip side is don't do it, then the other knee goes (40-60% chance) and then the dog effectively loses use of back legs (poor quality of life, painful, and cannot do what he loves - work). Would have to import a dog wheelchair. Arjen had a point of seeing if a human orthopaedic surgeon could perform the surgery. When I first moved here I asked about dental issues, the clinics at the time in my province said they do not do teeth. I asked can you get a dentist in, they looked at me with a <deleted> expression. The joys of Thailand. 

One other surgery option (Tibial Tuberosity Advancement) which heals a lot quicker, just depends if Khon Kaen has that one.

This is the TPLO (Tibial Plateau Leveling Osteotomy) that they can do. 

[Sheryl]

Afraid I don't know re KK.

Of all the vet hospitals in Thailand Chulalongkorn seems to have the highest capacity followed by Kasetsart. So if you want to go where the odds are greatest of getting treatment I'd say Chula.

Another option is that one of the Profs at Kasetsart has a private clinic out near Suvanabhumi airport and speaks English well. You could try calling him and ask if he is able to get one of the orthos from Kasetsart to do this at his hospital. Would cost quite a bit more but you could find out and schedule in advance.

Dr. Tony
Parichart Suwinthawon Animal Hospital
www.psahodpital.com

Dr. Tony is not an ortho himself but he owns/manages the hospital and could presumably discuss with his colleagues from Kasetsart.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[wildewillie89]

11 minutes ago, Sheryl said:

Afraid I don't know re KK.

Of all the vet hospitals in Thailand Chulalongkorn seems to have the highest capacity followed by Kasetsart. So if you want to go where the odds are greatest of getting treatment I'd say Chula.

Another option is that one of the Profs at Kasetsart has a private clinic out near Suvanabhumi airport and speaks English well. You could try calling him and ask if he is able to get one of the orthos from Kasetsart to do this at his hospital. Would cost quite a bit more but you could find out and schedule in advance.

Dr. Tony
Parichart Suwinthawon Animal Hospital
www.psahodpital.com

Dr. Tony is not an ortho himself but he owns/manages the hospital and could presumably discuss with his colleagues from Kasetsart.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

My vet who just set up clinic here and diagnosed him graduated from Kasetsart and is an ortho specialist (other vets had no idea and didn't want to touch him). He said they do TPLO surgeries at Kasetsart, however, he had never seen it done on a bigger dog there. His quote (estimate) was twice as much as Khon Kaen due to size alone. I will try and find out how often each place does the surgery and then combine that with the other variables (distance, cost etc). 

Thank you for the contact details. 

Edited November 6, 2018 by wildewillie89

[wildewillie89]

Update:

Yesterday we spoke to the Parichart Hospital. They said they do TPLO surgery in their clinic but cannot do our dog as it is too big, they do not have the specialist equipment for a dog that size. They suggested similar places as other vets and members have - Chulalongkorn, Kasetsart or Taling Chan Hospital...I think the later is a private one. 

They are of the opinion the cost of surgery at somewhere like Kasetsart will be approx 40,000 baht. But that would not include sedating the dog to have a feel of him, x-raying him and taking bloods to make their diagnoses. Also would not include the pain killers, antibiotics and follow up x-rays/visits after the surgery to make sure things are on track. 

Regarding TTA surgery - my preferred option with this particular dog as it is less invasive and the dog recovers quicker. They said TTA is crazy expensive in Thai as it is something new which requires new technology so they said better to go for TPLO.

So price seems only about 10,000 baht more (instead of 30,000 like we originally thought)  than say Khon Kaen, the only issue with Kasetsart or Chula is the travel. Those places are a good 200km (400km return) further, and for something like this that needs not only pre-visits but also follow ups it will make it difficult. This is a large working dog that doesn't let anyone within a couple of metres of him/car/or us, not a friendly Labrador being transported.  

Next step will to be to try and find out how often the surgery is done in Khon Kaen to see if they are a viable option regarding success rate. If not, then we will just have to travel. 

Edited November 8, 2018 by wildewillie89