I have been worrying over Willow and the recent decisions I've made regarding her care. I've felt somewhat pushed into the cruciate surgery (I tend toward conservativeness for treating such problems), when in fact the whole issue with her heart seems a more pressing matter. I finally called my alternative vet today, only to find that there was a three-month wait for an appointment. It's been getting more difficult to get in to see Regina as more and more people discover how wonderful she is (and to think she moved to a small rural community in Virginia so that she could have a more quiet practice than the big New York practice she came from). Regina offers holistic and alternative therapies, as well as physical therapy for dogs. I have seen a number of dogs she's worked with--dogs who were declared not likely to ever walk again, and yet there they were, walking. She worked with me and Jill after her hip dislocation, when my regular vet told me I'd have a better chance of winning the lottery than having Jill's hip stay in place (given that she has bad hips to begin with), and a partial cruciate tear that likely occurred during the accident that caused the dislocation but was overlooked because of the hip. Through a regimen developed by Regina, we were able to work Jill's hip to keep the good muscling intact (it's what was holding her hips in place after all) without putting undue strain on her knees. Within 6 months, I had a dog who was capable of running an open trial course again. She also worked wonders with my old dog Boy. Is it any wonder I trust her so much?
So when I found out I wouldn't be able to see her anytime soon, I was a bit saddened and upset. But her receptionist said she'd have Regina call me, and just a little while ago, she did. I was able to discuss all that's going on with Willow and get some good advice on how to proceed. The biggest thing that has been nagging me is Willow's heart. She has a grade 4 murmur and some heart enlargement, for which she was put on an ACE inhibitor and furosemide, a diuretic. What concerns me most is that the Enalapril can have a deleterious effect on the kidneys, something the regular vet didn't warn me about. He made no mention of rechecking kidney function after starting the Enalapril (she had baseline bloodwork back in January before surgery to remove a mast cell tumor), which apparently is fairly standard. One of potential side effects of Enalapril is inappetance, and Willow is already exhibiting that. And yet, here I am facing ACL surgery, which is quite expensive. I was wondering which problem I should be focusing on, and it didn't seem that the ACL was it, especially given that she is retired from working.
Regina is also conservative when it comes to surgery for ACL tears. She feels that if the dog is putting weight on the leg, there's not a need to rush into surgery. That said, she thinks I should restrict Willow's extreme activities, not only to prevent any further damage to her stifle, but also because bursts of extreme activity cause a sharp increase in blood pressure, which isn't a good thing for a heart that's already compromised. (Hmmm...something else the regular vet didn't mention--maybe I just didn't ask enough questions that day.)
So she suggested that I wouldn't be making a huge mistake to hold off on the ACL surgery and instead use the money to see a cardiac specialist in order to determine just how compromised her heart function is (and perhaps exactly what the problem is as well). Once we know that, then we can better form a course of action that will help increase her longevity without (hopefully) also creating potential problems elsewhere (e.g., kidney damage).
In the meantime, I will buy an above-ground swimming pool and put both Willow and Jill on a swimming regimen. It will help Jill to maintain muscling in her hips, which is important now that she's pretty much fully retired at age 12, and it will give Willow a low-impact, heart-friendly means of exercise (she'll be swimming assisted so as not to stress her too much). I started Willow on prolo therapy and will continue with that, although I'll cancel the surgery for now. I will also be adjusting Willow's diet to take into account both her heart and kidney function. If we can do all that, perhaps we'll get to September and our visit to Regina in better shape than where we are right now, or at least in no worse shape! It feels good to have made a decision I feel more comfortable with.