Month: March 2017

Monday 3/27/17 – Tues. 3/28/17

We are Icing Rose’s knee a few times each day, as she has quite a bit of swelling distal to the knee.  It’s hard to elevate the leg of a young dog.  Pillows make for good eating!  So, we are just making sure to keep it cool to reduce swelling.

Rose seems to be in less pain, and because she has not had a B.M. since her surgery, we’re giving her pain medication less often.  She’s still on a anti-inflammatory, so that helps with pain, but narcotic medications increases constipation, and we don’t want that!   Pain is a natural part of healing, and as long as she is not distressed (crying or agitated), pain keeps her off that leg and quiet.

But, Rose is starting to show signs of boredom.  Since she was on crate rest for almost three weeks before her surgery, it makes sense that this poor 7 month old is going out of her mind with boredom.  If she is not in her crate, she has to be tethered, to prevent jumping or walking around on that knee.  But she’s starting to look a bit pitiful.

Yesterday we decided to buy her some interactive toys, and take her with us in the truck.  When the back seat lays down, it provides a perfect flat surface for her to travel on, and maybe seeing something other than our den will help liven her up:

Rose, want to go for a ride?

She looked at everything along the ride!

She came home exhausted, and slept for hours.  Oh, and when we came home, and she had her first B.M. since surgery.  Yay!

We bought a few interactive toys for her, and they should help entertain her a bit more.   She’s enjoying them today.(Tues 3/28/17)

3/26/17

We won’t be updating every day, but for the first day or two, there is a lot to cover with respect to care of a dog with a fresh TPLO surgery.

Rose’s mood has greatly improved. We had her on a baby monitor all night and did not hear a peep from her. No more crying this morning either. She’s hooked to our baseboard (eyebolt and tether) so that she can not get any further from her crate than she is now, and can’t attempt to roam, jump or otherwise use her leg. Her incision looks great. She has quite a bit of distal swelling, but almost no bruising for now. It’s hard to keep an ice pack on it, as she wants to chew it, and if I sit with her, she wants to play, so I give her a treat puzzle to keep her busy while the ice is on. The ice pack still wants to slip off her knee (we had it covered with a pillowcase so as not to be directly on her skin).

While folks have been using a bag of peas for ice packs for a long time, I came upon a better idea years ago, that you may wish to try;

While we were trying to provide her with a nice-thick place to lie down, she became very distressed on the overstuffed bed. When we put her in her crate last night she settled down completely. All her crate has in it is a horse stall pad, which is a thick rubber pad. We assumed she might vomit during the night, or have a bowel movement or urine, as she was sedated and was medicated for pain, but we found she settled down greatly when put on that hard rubber surface. It would seem that the overstuffing was causing pressure and pain. We’ve removed that, and just laid down some flat bedding for her. She has been in the crate so long and is so good about staying put when on the floor (she’s tethered to the wall with a leash to prevent her from walking about), that when we’re in the room, we let her lie there.

Thick bed vs thin bedding … thin equals more comfort for her.  She can finally relax:

Her wound looks amazing, and I found a better way to ice her knee.  I use 4″ colban wrap (LOOSLY) around the pack, which holds the ice pack on, and she’s tolerating that well.  She has some distal (below the knee) swelling in her hock that I want to reduce, and five she was only able to tolerate a few minutes of icing otherwise.  She thought I was there to play with her, and wiggled around so much, that the ice pack would not stay on.  Problem solved.  Remember, always put something between an ice pack and the skin, as you do not want to add frostbite to your list of problems!

The wound looks amazing, and we solved the problem with the ice pack that wouldn’t stay on her knee.

She’s getting the idea of assisted walking:

3/25/17:
We were at the office to pick up Rose at 8:15am.  She’d had a hard night, which is to be expected.  She had vomited, had some diarrhea, and cried much of the night.  They had treated her pain, and sedated her, but she was still quite uncomfortable.  We left with our girl, and the following meds: Pain med, sedative, antibiotic, and anti-inflammatory.  She is now to be only walked to go potty, navigate no stairs, no jumping or playing.  She is to be kept off her leg for the next six weeks.   Right now, she will be supported while walking, to protect both her surgical knee and her other knee (reduce the stress and strain on the good knee, which often incurs so much injury from acting as the only good leg, that it too ruptures).  One can use a towel as a sling, but we have found a horse cinch to be useful in the past for old dogs who can’t get up, that we bought a new one (we wanted no bacteria near her surgical site by using an old one).

But for now, we’ll carry her.  She’s confused and in pain:

How much pain?  This should demonstrate that well.  This was our drive home.  Even with pain meds and sedatives, she was just plain miserable!  Her pain broke our hearts.

We prepared for a rough night, but after getting home and in a crate she recognized, and with the sounds of home, she settled down.

Rose’s knee showed great improvement on the anti-inflammatories. Her limp decreased greatly. The swelling in her knee went way down. We weren’t fooling ourselves, she was on an anti-inflammatory, and since it may have been be a partial tear of the CCL, rather than a full tear, but we knew a partial tear of the CCL can go complete in the bat of an eye, but at least we had improvement, which gave us hope that she had only sprained her knee.

Her follow-up Vet. exam dashed hopes of a sprain. With a considerable amount of swelling down, he now could feel significant drawer sign. He confirmed great suspicion of a CCL tear. We decided that rather than have our regular vet do the fix, that we’d go to a surgical specialist in Spokane, WA, to which he was in full agreement.

Her appointment with the Specialist was just shy of a week later.  Rose had been on strict crate rest for over 2 weeks.  That’s pretty hard on a 7 month old puppy.   The Orthopedist examined Rose, and scratching his head, stated that there was a little drawer sign, but not much more than on her good knee (normal “puppy drawer”). She has a grade 2-ish limp. No pain on exam, the patella is rock solid, and he gets no “pop” from the meniscus. Not completely sure, we agreed to more x-rays to see what it looks like now that the swelling is down.

   
Rose, patiently waiting for her exam at the surgical specialist’s office.

At worst, it would be a early CCL partial tear. At best, a grade 3 sprain. While we waited for x-ray results, we weighed our options for repair should it be a partial. We know darned well, it will become a full eventually if it is, but the question is conservative vs dynamic repair (anterior suture vs TPLO). Exploratory surgery for diagnostics was not an option as it just introduces other potentials in the joint that nobody wants, related to unnecessarily risk.

She was sedated for her x-ray, and x-rays of both of her knees (for comparison) were taken.  While she was sedated he manipulated her knee again, and now that she could not resist, he could clearly feel drawer sign.  She had a tear.  We suspected it was partial, but partial is like a frayed rubber band, just ready to go.  Full rupture would be inevitable, or she would develop a great deal of scar tissue to protect the joint.  With her being only 7 months old, we believed the only option was full dynamic repair (a TPLO – TIBIAL PLATEU LEVELING OSTIOTOMY)

We signed the consents and left our baby in their care, to have surgery that day.  The cost including the x-rays that day would be just short of $3,500.  We went home to await word.  We knew she would be staying at the office until the next morning.

Rose: Note the swelling in her left knee:

Our poor baby!  It breaks my heart to see her hurting.

She saw the vet a few  days later. Her diagnosis at the vet was inconclusive, where she is swollen and lame, x-ray and manipulation diagnostic for ligament injury didn’t reveal anything positive, and there is no fracture, so, the vet wants strict joint rest for the next 10 days.  He could not feel “drawer sign” in the knee, but the knee was quite swollen, and likely the swelling itself was splinting the knee from providing him with exam clues.  X-ray showed a great deal of effusion (swelling).  Rose will be living in a crate for the duration – rather like strict bedrest.   Since I’m sitting in the den, I lifted her into the couch with me (no jumping up or down allowed), as a seven month old needs physical contact, especially Rose, who is a lovebug!   He put her on an anti-inflammatory, and suggested we keep her on that for 10 days, then re-eval the knee.  In the meantime, she would be on strict crate rest.

We went home, suspecting that we were looking at knee surgery for our girl, and had decisions to make with respect to the type of surgery we wished to do.

Click here for a Description of CCL injury and treatment

This is Rose on day two of her CCL Injury treatment with anti-inflammatories and crate rest only.   She is trying to use the leg, but clearly it is swollen and painful.