New kitchen light

One more time I had to undo one of Mr.Brook's "works of art" to properly install a light that was completely out of code. Now, we finally have all the light fixtures replaced and wires insulated in the kitchen.

Andres.

I got my work chair

I bough a Stellcase Leap leather chair on eBay. The chair is new and it has all the features of the ones that go for $1300 online directly from Stellcase, but for half the money!!! Let's see if there's any trick that I missed.

Andres.

Sammy and his leg

We cut the Deramaxx on Thursday and only gave Sammy half a 75 mg pill on Friday. I am not sure he's not in pain. He is fine, but he's a little down, so I think we are going to give him 3/4 of the 75 mg pill tonight to bring him back over the 40 mg minimum that he needs. The surgery is going to be on Friday and the lab work on Thursday, so his last day on Deramaxx is going to be Tuesday.

Thanksgiving with the Beers

We had a fantastic Thanksgiving with Chad's family. It was really nice to hang out with Chad and Sono, and meeting Chad's family was a huge plus. 

I have to keep this in mind

I want to have the serenity to accept the things I cannot change,

The courage to change the things I can,

and the wisdom to know the difference.

Quiero tener la serenidad para aceptar las cosas que no puedo cambiar,

El valor necesario para cambiar las que sí puedo cambiar,

Y la sabiduría para apreciar la diferencia.

We will continue with Deramaxx

I talked to the clinic today for Sammy's medication and they said that I should continue giving him Deramaxx. I didn't talk to the same technician and I didn't get the same quality of service than before. I asked if I should modify the doses or extend the washout period before the surgery, but I only got a simple "just give it the same you have been giving him", which is exactly what all the vets of dogs that have died say. They didn't ask me if I was curious because Sammy was having symptoms and they didn't even question the washout period change. Is it that nobody cares anymore?

I also called Sammy's regular vet and left a message for her. They are probably not working today, but she might check her messages.

Andres.

Has Sammy been taking Deramaxx for too long?

Now I have to worry for the medication that we have been giving Sammy. Apparently, the Deramaxx is not as safe as advertised, or at least it has the risk of complications if taken more than 7 days as post-surgery medicine.

http://www.usatoday.com/money/industries/health/drugs/2005-04-11-dog-pain-usat_x.htm
http://network.bestfriends.org/newyork/news/4001.html
http://www.dogsadversereactions.com/nsaid/memorial22.html
http://www.dogsadversereactions.com/nsaid/internetreaction.html
http://www.caberfeidh.com/Pain3.htm
http://www.cafepharma.com/boards/archive/index.php/t-27329.html

There's a lot of misinformation going around, I am sure, but there are also a lot of reasons for not trusting pharmaceutical companies.

I found the following in the study that Novartis posted with the FDA (http://www.fda.gov/cvm/FOI/141-203.pdf).

"Results of the study demonstrate that DERAMAXX™ Chewable Tablets are safe and effective when administered at a dose of 3-4 mg/kg of body weight once daily for a maximum of 7 days."

We have been giving the drug to Sammy for a month!!! The surgeon in Bellevue gave us more Duramaxx, and he also changed it from half 100 mg to one 75 mg, so he actually raised the doses.  

From: http://www.dog-arthritis-resource.com/deramaxx-warning/

"It took 11 months for Novartis to even begin to comply with FDA regulations, yet at the same time they were able to obtain permission to market their product to an even wider market. Does this seem logical to you? Is it any wonder that so many people are afraid to trust drug companies to do what is in the best interest of their dog? When you consider that the FDA actually receives less than 1% of serious ADE reports, it really puts things in perspective.
As of January 3, 2005 the FDA released the following numbers:

Deramaxx Reviews: 2352

Treated: 2400
Reacted: 2371
Died: 515

This number is staggering. More than 20% of the dogs died after being administered Deramaxx. The number is even scarier when you consider the amount of cases that go unreported."

This is the data directly from the FDA (http://www.accessdata.fda.gov/scripts/animaldrugsatfda/details.cfm?dn=141-203):

Sponsor: Novartis Animal Health US, Inc.

Ingredients: Deracoxib

Exclusivity: Granted for the additional claim of control of pain and inflammation associated with osteoarthritis in dogs. No product using deracoxib as an active ingredient has been previously approved for use in dogs in any other application.

Specifications: Each chewable tablet contains 25, 50, 75, or 100 milligrams (mg) deracoxib.
Conditions of use: Dogs, weighing more than 4 pounds. Amount: 3 to 4 mg per kilogram (1.4 to 1.8 milligrams per pound) of body weight once daily for up to 7 days, given orally.

Indications for use: For the control of postoperative pain and inflammation associated with orthopedic surgery in dogs weighing 4 or more pounds (1.8 kilograms).

Amount: 1 to 2 mg per kilogram (0.45 to 0.91 milligrams per pound) of body weight once daily as needed, given orally .

Indications for use: For the control of pain and inflammation associated with osteoarthritis

So, since Sammy weights 90 pounds, the doses for postoperative pain would be 126-162 mg and for control of pain 40.5-82 mg. We have been giving him 50 mg (half of a 100 mg tablet) and recently 75 mg. I am going to consult with the veterinarian tomorrow to see if I should stop it completely or reduce the doses.

Andres.

Sammy's surgery is scheduled

I scheduled surgery for Sammy for next Thursday December 5th. He has to go in the 4th for the analysis and stay most of the day there. I will stay and bring him back home at night. Then, I will take him back early on the 5th for the surgery. He will spend the night of the 5th after surgery in the clinic and I will pick it up the next day in the morning on Saturday. He cannot eat the day of the analysis and I will stop the painkiller he's taking on Tuesday.

Andres.

La Negra found one new level of comfort

Just unbelievable. We were watching a movie and all of a sudden Julie turned around and found this.

Andres.

Requested appointment for Sammy's surgery

I called and left a message requesting an appointment to do Sammy's
surgery. Unfortunately, they are out of the office for thanksgiving,
so it's going to be next week.

Andres.

Julie and Negra - Washington Park

Today Julie had the great idea of going for a walk at Washington Park. My back hurt today, so I stayed with Sammy here and Julie took Negra with her on a "girl's outing". 

Andres.

Going public with the blog

I decided to make this blog public!

Andres.

Appointment at NWVS

Today I took Sammy to see Dr. Lozier. I couldn't be happier with the level of knowledge and quality of the consult with him. Dr. Lozier is not only a good surgeon with vast experience, but also a gentleman. He spent over two hours with me explaining every detail I asked for regarding stifle injuries and the treatment options.

Dr. Lozier doesn't favor TTA over TPLO, because he says that they are both good techniques and a good TPLO is the best option he knows and recommends. He mentioned what he knows about tightrope and he personally knows Jimmy Cook, who invented the technique. Dr. Lozier explained to me that regardless the success of the tightrope technique, it's really no more than another option from the traditional techniques, and he also agreed that Sammy's stifle doesn't make him a good candidate for the technique. Dr. Lozier did a complete exam of Sammy checking for not only the stifle but also for any other thing that could get in the way or should be treated. I finally felt that somebody really care for the dog they are treating unlike all the other places where I took Sammy with the exception of Dr. Aluas.

I am almost 100% sure that TPLO is what we have to do for Sammy. Dr. Lozier explained what he knows about the small percentage of TPLOs that go wrong, and in his opinion most of them were technical errors. Dr. Lozier has performed thousands of surgeries and had only a few bad experiences due to complications, but he still explained that there's always the possibility of something going wrong.

Sammy is using his knee more and more, but I am pretty sure now that he either will end up with chronic pain or is never going to recover acceptable functionality of this leg without surgery. The only problem with the surgery and the careful pre-surgical work that Dr. Lozier performs is that it's extremely expensive. This is going to either put a big dent in our savings, or maybe it's going to get paid by selling one of our cars, which would also help us save more money in insurance and gas just in case Sammy's left knee also fails. Unfortunately, regardless of the cause of the stifle failure, there is a 50 to 60% probability that the other knee would have the same problem.

11/15/08 12:28 PM

The idea was to get the cage before the surgery so Sammy can get used to it, but Negra just seems to be faster.

Andres.

New appointment with Dr. Lozier

I checked at Kyon Veterinary products that Dr. Lozier not only uses TPLO, but also TTA which was recommended by Dr. Aluas, so the day after the trip to Bellevue, I called NWVS again and tried to get an appointment for Sammy. Unfortunately, there was no openings until the 20th, not even with my birthday on Saturday the 15th I could get anything before. I guess I was being punished for canceling my previous appointment with such short notice... I hope not.

Tightrope surgery day

Sammy and I drove to Bellevue WA to see Dr. Mihai Aluas and get the Tightrope surgery for Sammy. We woke up at 4 AM to get ready and start the trip, but I barely slept anything anyway.

The drive took 3 1/2 hours because the traffic got really bad getting to

Bellevue, so we ended up taking some country roads, which were also crowded, but we made it on time for our appointment at 8:30 AM.

Dr. Aluas took Sammy for x-rays after chatting a little bit with me and meeting Sammy. I went and waited at the front desk for maybe 15 minutes. When Dr. Aluas came back, was to give me the bad news that Sammy has a very steep TPA, so the surgery would not work for him. Dr. Aluas recommended TTA or TPLO for Sammy instead of the Tightrope technique. Although it wasn't what I wanted to hear, it was the first time we got the level of knowledge and communication that I expected.

Dr. Aluas recommended the TTA technique because he had good experiences with it and it's less invasive than the TPLO surgery. The TTA technique relies on changing the forces in the knee to stabilize it by cutting the front of the tibia and pushing it forward with an 

spacer. The change of the angle happens without changing the load bearing parts of the tibia, so the technique its a little safer on that regard. Also, if anything goes wrong and the bone breaks under the screws, it's easier to fix a TTA than a TPLO surgery. If we decided to do the TTA we had to wait for 2 weeks and make another trip to Bellevue. We decided to wait and research some more. Dr. Aluas said that there was no urgency to do the surgery as longs as I
keep taking good care of Sammy as I have been doing. He did see some fluid on his knee, which can cause inflammation and therefore pain, but he gave us more medicine to take with us.

Andres.

No need for one more appointment

After researching some more, I decided that there was no need to have the appointment with Dr. Lozier, since Sammy would still get x-rays and examination from Dr. Aluas in Bellevue. If we still needed local help, I could make a new appointment with them and take Sammy there.

The decision about Sammy's surgery

After talking a lot, Julie and I decided to get an appointment with Dr. Aluas in Washington to do the surgery. I called Dr. Aluas and we scheduled the surgery for the 13th.

Since I was afraid that Sammy still have not been checked by a knowledgeable veterinarian yet, I got an appointment with Dr. Lozier for the 12th, so I would have his advice before making the trip to Bellevue. 

More on Tightrope

I continued researching about Tightrope CCL and calling veterinarians that use the technique.

I got in touch with Dr. Marks from Timberland Animal Clinic in Portland. They are licensed to do Tightrope, they are in Portland, but unfortunately don't have much experience with the technique yet. Dr. Marks was extremely helpful and shared with me what he knows about the technique and about the other surgical solutions for torn CCLs. He referred me to Dr. Scott Lozier from the NorthWest Veterinary Specialist clinic. I made an appointment to talk to Dr. Lozier.

I also got in touch with Dr. Mihai Aluas from the Aerowood Animal Hospital in Bellevue WA. Dr. Aluas was also extremely helpful and accessible. He could perform the Tightrope technique and he has also performed TPLO and TTA surgeries. I really like talking to him and got a ton of really useful information to make our decision.

I called another doctor in California, which was probably not a good option for us because of the distance, but he is one of the best surgeons doing Tightrope CCL in the west coast. I called Dr. Philip Watt from the San Francisco Veterinary Specialist clinic, unfortunately he was busy so I left a message for him. The good news is that Dr. Watt called me right away and spent a good half-hour on the phone with me talking about the technique and his experience with it. Dr. Watt is very comfortable with the technique now after doing over 100 of them. He did say that unfortunately there is no much evidence on how effective the technique is since it's too new.