Joint Relief

Second Opinion
By Nick Trout, September 2012, Updated February 2015

I consider myself to be an optimist, a “glass-half-full” veterinarian. So why was I so worried about Zeus, a four-year-old Great Dane mix?

“He’s been lame for a couple of months,” said Jeff.

“And he’s very active,” added Jeff ’s girlfriend, Adrian. “We run six miles, five times a week, and go to the dog park for an hour or so every evening.”

Zeus had been referred to me for a torn cruciate ligament in his left knee — a perfectly reasonable diagnosis. But what I was seeing didn’t align with it. For starters, he held his withered leg totally off the ground, and when I palpated his knee, it felt stable. His X-rays confirmed the presence of arthritis, but it was mild, not enough to account for his apparent discomfort.


Sign up and get the answers to your questions.

Email Address:

“Something doesn’t add up,” I said, trying not to sound like a pessimist. “I’m worried that I may be missing a bigger problem.”

Jeff seemed wary and Adrian looked alarmed, though she later confessed that she had suspected as much.

“I’d like to anesthetize Zeus and feel the knee when he’s totally relaxed, then take another X-ray. If everything jibes, we’ll go straight to surgery and fix the problem.”

However, my examination while Zeus was anesthetized failed to expose joint laxity, and I began to worry that the changes I saw on the X-ray weren’t the result of arthritis but rather, a tumor in the joint.

“I’d like to take a biopsy,” I told Jeff. If he was losing patience, he kept it to himself. When the results came back normal, I had to make another difficult phone call — difficult because I still didn’t have an answer.

“I don’t want this to be something bad,” I said, “but I’d also hate to put Zeus through a surgery that doesn’t address the real problem.”

“What do we do now?” Jeff’s flat tone revealed his waning confidence.

“Let’s put a scope, a camera, inside the knee. If the ligament’s damaged, I’ll see it and repair the knee. If not, I’ll keep hunting for what’s wrong.”

I tried to put myself in Jeff and Adrian’s position; they must’ve felt as though they were dealing with a cagey Dr. Doom. They wanted me to fix their dog, not speculate on the ways in which Zeus’ problem has failed to match up with my textbooks. Would they seek another opinion? After all the money they’d spent, poor Zeus was still not better.

Fortunately, I got my chance to look inside the joint, discovered that the ligament was partially but significantly torn, and verified the need for corrective surgery. Even so, when Zeus returned for his six-week recheck, I braced for the worst: a dog still struggling to get around on three legs.

Sometimes, it’s good to be wrong. Zeus was bouncy, fresh, eager to play and using the leg very well for this stage of his recovery. Now that we were out of the woods, I felt as though I could speak frankly with Adrian about my concerns, and encourage her to come clean about her own perspective on the process I’d put them through.

“It was frustrating,” she said. “Jeff and I definitely got into a lot of … disputes. We thought about not doing surgery, about going somewhere else. In the end, I realized you were just being thorough.”

I made sure Adrian knew how grateful I was that she had kept the faith. Though I’m a surgeon, I’m not married to the adage, “cut to cure.” Despite my initial negativity, I had done my best to be honest, voice my fears, take time to listen, be rational about my approach and, most of all, make sure they understood that my hesitation was rooted in what mattered most: doing right by Zeus.

“When did you know he had turned the corner?” I asked.

“The first week was tough,” said Adrian. “I was still worried. But Zeus loves two things in life. He loves to chase his tail, and the day I saw him spinning around on his back legs trying to catch it, I cried because I knew my boy was back.”

“What’s the second thing?”

“His orange ball. For the first time in months, he found it and brought it to me because he wanted to play fetch. No doubt about it, he’s on the road to recovery.”

I smiled and kept a reprimand about premature ball-chasing to myself.

Article first appeared in The Bark, Issue 70: Jun/Jul/Aug 2012


Nick Trout is a Diplomate of the American and European Colleges of Veterinary Surgeons and a staff surgeon at Angell Animal Medical Center in Boston.