Leg injury confusing the vet

Question

My doberman puppy (10 weeks) hurt his leg playing on the stairs a couple weeks ago. The vet said no hurry for bringing him in, since large dog breeds pull muscles all the time.

When we got him in, the vet took an x-ray and showed us what looked like a fracture, but with some weird swirling patterns around it that she has never seen before, and didn't know what to make of. We let her take another x-ray. She still has no clue.

Possibilities she has thrown at us go all the way from bone cyst that would require removal of the leg-bone to an old fracture (perhaps right around birth?) with the swirling indicating remodeling of the fracture, which my pup subsequently aggravated. It's been about a week since the visit, and he has a supportive wrap on his leg that lets him put pressure on it and walk around.

I swear I can't let him out to pee or eat without him doing his best to tear around the house. He doesn't appear to be sick or in any pain, and I think he is actually bouncier and more energetic than our great dane pup (1 year now) ever was. Nothing but nap-time is keeping him from playing.

If he had never gotten the xray, I wouldn't be concerned about him right now AT ALL, assuming he could use his leg without the cast. (He was starting to walk on it, gently, right before he went to the vet).

Now the vet wants to take a couple more xrays($$) send them off to a specialty service($$) test for valley fever($$), test for a bone infection($$) and some other stuff, too. We have spent close to $700 on this pup in the last month, a couple hundred more on the dane, had to put down a cat with an incurable virus infection, and we are raising 4 children. The money just isn't there for all of this.

What are things we should focus on, since I can't afford to focus on everything?

Answer 1

I'm not familiar with dogs, or bone diseases in particular, but I've had a long series of sick cats, so this is my advice in the general case of "my vet just gave me a long list of possible tests that we can do, what should I do with it?"

For each test, you should ask the following questions:

1. What will we learn from this test? What illnesses/diseases/injuries are we trying to confirm with this test.
2. How likely is that particular problem in my pet? Consider age, sex, breed, general health, history, etc. What causes the particular problem the test is looking for and does that make sense for my pet?
3. If that is the problem, what will the treatment be? Some illnesses just require palliative care (take care of the symptoms like pain, but otherwise will resolve on their own). If the most likely outcomes won't change your treatment plan, then there may not be any reason to test to see exactly what it is.
4. If that is the problem, what will happen if we wait to treat? If you decide to take a stepwise approach (let's do the test for the problem that's the most likely), what is the risk in possibly not treating for the other conditions. Is your dog in pain/discomfort? Will the problem be made worse if you wait (like a bone fracture healing incorrectly)

The things to keep in mind during this (long) discussion with your vet are

• What are the most likely problem(s)?
• How will the possible diagnosis affect treatment?
• Which potential problems are time sensitive?

Example

I once noticed a problem in my cats' litter box, but I didn't know which cat it was (or what the problem was), so I took both cats to the vet (I had 2 at the time). The vet I was seeing at the time gave me a long list of pretty much every urinary test imaginable for both cats, it was super expensive! I went through the list of tests with them, looking for one that might at least identify WHICH cat was ill. The $15 "look at the urine under the microscope" test was fast, inexpensive, and should at least tell us which cat was sick. So I saved a ton of money by not doing any further tests on the cat that was well.

The downside to this method is that things can drag out a lot longer. Our cats have had some kind of skin issue for several months, and rather than doing expensive tests to figure out what it was, we decided that it looked like ringworm, that's very common, and if it's not ringworm the medication won't hurt them, so we'll go ahead and treat for it. After several months of treatment (shampoo and oral liquid), my regular vet gave up and sent us to the specialist. If we had tried to do tests immediately, we would have skipped 6 months of treatments that didn't work.

For your specific case, I would suggest reading on the specifics of Valley Fever and bone infections to see how likely they seem for your dog. Valley Fever in particular is a very localized disease, and it only makes sense to test for it if you live or have visited there.

Answer 2

It seems like nothing that is likely will progress very quickly, so we are going to keep his leg wrapped for a few more weeks in case it was a new fracture and let the vet take another xray. I don't think there would be much change over the course of last week to now, so not much to learn here. all the tests seem to be aimed at ruling things out because of the abnormal image, not because of my dogs symptoms. For now, it seems that the things the vet are worried about require either huge treatment(removal of a bone) or courses of antibiotics. Since the larger treatments don't seem to be related to whether we catch it now or in a month, and our dog is happy, we are going to wait a few weeks and xray again. If he starts to act sick or abnormal, we'll head back to the vet.