Day 10 Post-Op

Saturday, May 31, 2008

Not too much has been happening, so I anticipate I won't be giving daily reports as often anymore.

We're in the double digits now! I guess you can call us CCL Teeny Boppers. =P

As you can see in the photo to the left, 10 days post-op and 22 days post-rupture, her thigh muscles are already pretty atrophied. The x-ray on the day of surgery showed that her affected leg was already a bit atrophied, but now it's starting to get visually skinny. She uses it and puts some weight on it, although crate rest and limited activity is obviously taking its toll. I can't wait to get the go-ahead from our doctor to begin hydrotherapy so that we may begin to rebuild muscle tone.

I took the picture while giving her a rub-down pre- and post-PROM (passive range of motion). I am still having difficulty getting a smooth range of motion out of that leg. It's like she eases up and lets me do the bicycle motion with her leg (manipulating her hip, knee, and hock joints at various times), I extend her leg all the way, begin to flex her knee and hock, but when it comes to tucking the leg in to her belly to complete the movement, she yanks her leg in. It seems like something is uncomfortable or "catching" in the knee that prevents the knee from moving fluidly. I hope it is purely a matter of being too "fresh" in the knee still and more PROM work will help to stimulate the synovial fluids in her knee and allow for improvement.

I also do PROM on the individual joints of her leg so that I may monitor and improve the range of motion in the individual joints. Currently her hip and knee have good range of motion, but her hock (ankle) is not as free as the good leg. She can not flex the hock to as acute an angle as the healthy leg.

This may seem strange since the knee is what was operated on, so let me explain...

This is the surgery performed on Sophie's knee
http://www.vetsurgerycentral.com/cruciatelrt.htm
(I hope that I am not infringing on any copyrights by posting their picture here, so let me just say that this image is NOT mine and I am just displaying it in this blog to illustrate a point. The link above is the owner and original location of the image.)


This is how the tibia "thrusts" forward when the hock is flexed when the cruciate ligament is ruptured. This is the tibial compression test. What I am speculating is that while the knee is stable from the surgery, it is still causing Sophie some discomfort when the hock is flexed as the tibia tries to "thrust" forward.

Then again, I am by no means anywhere near an authority on canine orthopedics and I am just speculating as to the reasons for her impaired range of motion in the hock.

I would also like to add, that while Sophie is out with us in the living room hanging out on the floor, she is ALWAYS on leash. This is so, so important for these post-op dogs. Keep them on-leash, even if it is just attached to their collar and you are not holding it!

And last but not least, today's photos of her incision:

Day 8 Post-Op

WooHoo!! We're embarking on week TWO!

Sophie had all 13 of her staples taken out today. The vet looked at the incision site where I was having worries and said that it looks like it has healed well, just that the skin has "lipped" and so the exposed edge of the incision is what was scabbing. Now that there are no staples pulling the skin together, the edge of the incision that "lipped" is exposed and raw. I am sure that it must sting or be uncomfortable in some other way, plus I bet it is itchy as hell! So, while Sophie has been an angel about not bothering her staples, she has started to lick the incision! On goes he e-collar. She looks thrilled, no?

I put a bandaid with some neosporin on the exposed tissue. The rest of the incision looks beautiful!


The exposed "lip." It looks wet because of the neosporin.

Day 7 Post-Op

Wednesday, May 28, 2008

Nothing too interesting to report today! No news is good news, huh?

I've been asking around on the orthodogs yahoo! group about the thickening in her knee and her incision. No real concern, I guess. The thickening is typical of post-op cruciate repair. The incision looks clean and relatively well-mannered, although the bottom is still bothering me. No angry infection here!

I would like to commemorate the last day of WEEK ONE! We made it! Taking it day by day and week by week really helps. A watched pot never boils, so don't stare at the calendar and how much time you have left. Concentrate on getting through each day and don't beat yourself up for some small mistakes. Sophie snuck up on the couch while I was cooking and Pete was supposed to be watching her. He got a little too engrossed in the Lakers game and she hopped up on the couch. The princess likes a soft spot for her highn'ass. The couch doesn't sit very high, so it wasn't a big leap to take to get up there, but practically gave me a coronary when I walked in the living room and saw her on the couch!

Day 6 Post-Op

Tuesday, May 27, 2008

Sophie successfully scratched her ear with her bad leg today! She had her medicine as usual today. I called the vet's office to get the OK for taking her off of all pain medicine. I feel like it might give her a false sense of confidence when it comes to her leg. I want her to feel some pain so that she doesn't do too much too soon with it.

Her incision is still looking a bit ugly on the bottom 5 staples. Her knee also appears to be very thick to me. I assumed from inflammation, but it is a hard swelling, not soft like I would expect from her soft tissues.

Day 5 Post-Op

Sophie hung out with us on the grass today. Pete worked on his car and Sophie and I basked in the gorgeous May day. She sunbathed and I read my book. :)

She is being good about hanging out in the living room on her make-shift bed and pillows. Sophie still has some edema left around her ankle and her naked leg is still flushed. I think that it might be from exposure to the sun combined with a bit of irritation from getting shaved.

I did not give Sophie her pain meds tonight, just her Baytril (antibiotic). I noticed that the last 5 staples worth of incision doesn't seem to be healing as well as the rest. It is still oozing a little bit and scabbing.

Day 4 Post-Op

Sunday, May 25, 2008.

Sophie is still doing well, nothing new to report.

She has a bit of edema (fluid) around her ankle. Poor girl has a cankle! This is typical of cruciate surgery-- all the swelling and fluid that builds up after getting the tissues disturbed eventually gathers at the ankle thanks to our friend gravity.

She is lifting the bad leg up to lick her belly and bathe her "nether regions." She also used the bad leg to try to scratch her ear.

Day 3 Post-Op

Today is Day 3 Post-Op... Almost half way to finishing the first week!

We took Sophie outside with us for some yardwork. The picture to the left is her set-up. Both of us got eaten alive by those no-see-ums. YEOW!

Sophie is having regular bowel movements twice a day, so I won't bore you with those stinky details. I will post anything irregular that might "pop up," though. I am carrying her down two flights of stairs 2-3 times a day to go pee/poop. It's taking a toll on my back, but a sacrifice I'm willing to take so that I don't take the chance of any "oops" moments on the stairs.

I have been adding a raw egg to her kibble to supplement her diet. I just mix it up with a fork or spoon and throw in her joint supplement. I also give her her pain meds and antibiotics in a piece of hot-dog. It ensures that she is eating her meds on a full stomach so that she doesn't get any stomach upset.

She is using her leg well. Echoing what others often say as their dogs settle in to the life of post-op, she is using her leg TOO well! I need to hold her back to make sure that she doesn't put too much stress on her operated knee nor her good knee and blow that one out while it compensates for her current disability.

Day 2 Post-Op

May 23, 2008.

Sophie is more alert today. It appears that she licked the blood off of the leg overnight. She has some bruising around the incision. Sophie is eating and drinking well.

The skin on her leg where they shaved seems to be red and irritated. I am going to look into it and see if there is maybe something I can put on it to provide some relief.

I did some passive rang of motion (PROM) exercises; flexing her hock, moving her leg at the hip and bending her knee. She only lets me do it a little bit and then tries to pull her leg away. I also iced her knee for about 5 minutes until she tried to pull her leg away.

She urinated but has not had a BM (bowel movement) today.

Sophie is toe-touching while walking with minimal weight bearing. She urinated twice before bed. I gave her Tramadol for overnight pain relief as well as Baytril and the joint supplement (she gets it 2x a day).

Day 1 Post-Op

I picked Sophie up at about 11:00am.

We were sent home with Baytril, an antibiotic, Rimadyl for pain, and Tramadol for severe pain. Maria, the wonderful Vet Tech at Hernas Veterinary Clinic, told me that she has been laying on both sides.

We got home at 12:00pm and she urinated as soon as I took her outside. She was not eating or drinking until later in the evening. It usually takes a dog up to 3 or 4 days to have a bowel movement, but Sophie had her first that night.

When I visited Sophie the day of her surgery, she had some dried blood around the incision site. The vet tech that I spoke to said that they didn't want to bother the leg and would clean it up before I took her home. When I picked Sophie up, she still had not been cleaned up. I don't know why they didn't just clean her up right after they finished the surgery and she was still anesthetized.

Surgery

May 21, 2008

We met with Dr. Conrad for a consultation. He has done over 2000 procedures, with only one rejection. It was a dog whose body simply would not accept the monofilament nylon (like heavy fishing line) or the Securors clamp (clamps the two ends of the nylon wire together).

He said that he has also modified the procedure a bit for heavily muscled dogs like Sophie, placing the mofilament nylon deeper in the tissues to make sure that it stays secure and tight.

We had radiographs taken of her knees and hips. Dr. Conrad said that he likes to x-ray the hips to make sure that there won't be any "surprises" down the road.

Now, remember that vet that told me years ago that x-raying the hips was unnecessary if she was asymptomatic? Well, to this day Sophie has never exhibited any lameness or discomfort in her hips. The x-rays tell a different tale. Sophie has Hip Dysplasia.

This was a devastating thing to hear. I have always been very paranoid about HD (hip dysplasia). I keep her lean and fit so that there is no excess weight on her joints or organs. A panic set in when I was reviewing the radiographs with Dr. Conrad. First a cruciate tear, now hip dysplasia?!

I needed to take a breath. Hip Dysplasia is not as condemning a diagnosis as it used to be. There are many options for managing the condition through diet and supplements and never needing surgery. Since Sophie has never shown discomfort from her hips, I believe that we will be able to manage the condition and keep her happy through a good joint supplement containing Glucosamine, Chondroitin, MSM, Vitamin E and Hyaluronic Acid. This will also do well for easing the arthritis in her knee.

I asked Dr. Conrad about the possibility of Sophie's other knee blowing out, since this is very common with cruciate injury. He said that because of her conformation, Sophie has an 80% chance of eventually needing surgery in the other knee.

Dr. Conrad said that he could do the surger today if we wanted. I did not want to wait any longer than I had to, so we left Sophie at the hospital for surgery. She was already sedated from the x-rays, so they shaved her down and scrubbed in for surgery immediately.

I was able to visit her the same day a few hours after surgery. This is what her knee looked like:


Sophie stayed overnight at the clinic.

Sophie's Cruciate: Intro

I decided to create this blog to track the surgery and rehab of Sophie, my American Bulldog. On May 9, 2008 Sophie tore the cruciate in her right knee.

I would like to preface this blog by saying that this is a personal account of cruciate surgery with my dog. Most things stated in this blog are a matter of opinion. If you have any questions or are experiencing this same injury with your dog, please contact a (few) board-certified orthopedic surgeons for consultations. All dogs are different and may require different procedures.

I will start with some background.

Sophie is a 60lb. American Bulldog. She was born December 4, 2002; that makes her 5 at the time
she ruptured her cruciate. She was purchased from a backyard breeder (BYB) in February of 2003 at 9 weeks of age. She is registered with the UKC as Shanghi's Sophie L'Oren.

Sophie has been active in obedience since she came home. Right after joining our family, Sophie and I started to train with the Schenectady Dog Training Club in Glenville, NY. We worked up the ranks to the Open level of AKC-style obedience. We also trained in Agility. Sophie liked to learn new things, but never seemed to show any spunk or real joy in obedience. I had been reading about Schutzhund for some time and decided to check out the sport. I e-mailed several local clubs, but only one responded to my interest. It seems serendipitous that they were the only ones to welcome us and I would not have it any other way. Liberty Schutzhund Club has given us a beautiful relationship and I have made some wonderful friends. They always supported me and my "unconventional" breed. I tried to list all of Sophie's vocabulary once, she knows over 60 commands.

After some investigation, we have deduced that Sophie partially tore her cruciate ligament over a year ago. She was being a bulldog and hunting for some critters behind the shed. I speculate that she snagged the leg on a branch or in a hole in the ground. She screamed, came up lame, and wouldn't let my mother touch her (I was not home). In true bulldog fashion, after maybe a day or two of limping, she seemed to recover. There were times when she came inside limping occasionally, but I always attributed it to a pulled muscle. I even took her to the vet who checked her over and determined that her hips and knees were sound and that whatever she was doing was just from being a crazy young dog playing too hard. I asked if I could get x-rays taken of her hips since she was a working dog so that I know that I am not taxing a weakened structure, but he told me that if she was not symptomatic, it was just a waste of money (more on this later).

May 9, 2008 Sophie was chomping on some grass (she was a goat in another life) under a berry bush in the yard, screamed and came up lame. After that, she was completely lame on her rear right leg. She would not put any weight on it.

On May 13, 2008 I took her to the vet who diagnosed her with a ruptured cruciate. Dr. Brennan confirmed this diagnosis by performing a drawer slide test and tibial thrust/compression test. She also had a medial buttress, which suggests that there is inflammation in the joint and arthritis was already setting in. The medial buttress is a swelling on the inside of the knee.

I was tormented about this diagnosis. Which surgery do I choose? Will it be the right one? Will it provide long-term stability in her knee and as sound a gait as possible? What about complications?

I asked my fellow dog-friends about their experiences and began my hunt for Sophie's surgeon.

A group that has helped me tremendously is:
http://groups.yahoo.com/group/orthodogs


Some links that have helped me during this process are:
http://www.vetsurgerycentral.com/ortho_TTA.htm
http://www.vetsurgerycentral.com/tplo.htm
http://www.vetsurgerycentral.com/cruciatelrt.htm
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=339306
http://www.veterinaryspecialty.com/TPLO.aspx
http://www.veterinaryspecialty.com/TTA.aspx

I called Cornell, Tufts, and Veterinary Specialties in Pattersonville, NY for information about our options. Price for a TPLO ranged from $2000-$2800 at Cornell, to $3100-$3300 at Veterinary Specialities. Tufts quoted up to $3500.

A friend referred me to a local veterinary clinic where she always brings her dogs. I called them and decided to schedule a consult for a second opinion. Dr. Hernas confirmed the initial diagnosis. Dr. Conrad, a board-certified orthopedic surgeon visits their clinic regularly to perform orthopedic surgery for the area.

We decided to have Dr. Conrad perform the "traditional" Securors cruciate repair surgery on Sophie. The possible complications with the TPLO just scared me too much. If I did not feel confident in the procedure, I wouldn't settle with having it performed. A good question to ask yourself is, "would I have this surgery?" I felt that I wouldn't have the TPLO surgery performed on my knee, so I didn't choose it for my dog.

I would like to add that I in no way mean that the TPLO is an inferior procedure. It has had much success. It is especially recommended for large dogs, but Sophie is a shrimp of a bulldog and so the "traditional" repair was an option for us. TPLO stands for "Tibial Plateau Leveling Osteotomy." In essence, it works by changing the mechanics of the knee and eliminating the need for the CCL. The "Osteotomy" part of the procedure means cutting bone. It is a much more invasive procedure and so carries more risk. All surgeries have possible complications, but the ones for this surgery were not ones I was willing to risk. If something goes wrong with the TPLO, it is often catastrophic and you have little to no options afterward. Some "minor" complications may be screws coming loose, rejection of the implant, etc. The "traditional" repair leaves me with many more options if anything were to possibly go wrong.