6 weeks under our belt

Today is officially the 6 week mark since Heidi's meniscus removal. Last time I checked in with you guys, I was a little concerned that she was still limping but was hopeful that it could take up to 6 weeks for the limp to go away. In the past week or 2 I have really noticed improvements. I think I mentioned before that Heidi's limp would worsen after our therapy walks. After a couple weeks of intermittent limping, I decided to rest her for a week. That apparently did the trick! Much to her disapproval, we reverted back to "outside for bathroom breaks only" for a week, and when we started her walks back up, there was a drastic improvement. She barely limps now and is much like she was BEFORE the meniscal tear. If you can remember back, she never fully recovered after the MMP surgery. When standing still she would favor that leg slightly and maybe had a barely noticeable hitch in her step. I'd say we're back there now and I am thrilled. We are about to bump her walks up to 20 minutes and we're still going to take it slow and not allow her to be TOO wild, but I definitely feel like we're back on track and I am pleased with her recovery. My parents, who see her every couple of weeks, said they noticed a huge difference on her last visit and I'd say it's only gotten better since then. So the lesson here is one of PATIENCE! I also think the rest really helped her, so although that wasn't what the vet originally suggested, remember sometimes you may need to alter "the plan" a little to do what you think is best for your dog :)

Week 1 of Rehab Walks Down

Alright, so this whole weekly update thing is not my forte this go around. I blame it on school. It's consuming my life! BUT, back to business, Heidi is still doing well, although we had a super small scare. Two Monday's ago, right after my last post, I came home from work and Heidi's incision was really really red and raw. She still had her stitches in and they seemed to be bothering her. I think the redness/rawness was from her licking them, so Alex and I decided to go ahead and take them out. It was day 11 post-op so it was within that 14 day window and I could tell the incision itself was closed. She would not let me touch that area so it made the suture removal pretty difficult. I forced my husband to hold her down (He HATES having to do that to his "baby") and I was finally able to get them all out after a huge struggle. I rinsed the area really well before and after with a disinfectant solution (Nolvasan) I got from the vet at another visit just as a precaution in case the redness was the beginnings of an infection, and decided to watch it closely for the next few days before panicking. I monitored her constantly for signs and symptoms of infection (increased redness, swelling, heat from the incision, smelly yellow drainage/pus), and luckily over the next few days the redness decreased and my worries slowly disappeared. Also, in the last post I talked about how crazy her knee looked because that one part was very swollen. Well, the swelling has gone down A LOT at this point and looks fairly normal (for a knee that has been through 3 surgeries)! I am a little disappointed because Heidi is still favoring that leg. We started her 5 minute rehab walks this week and they actually seem to make her limp slightly worse. At the same time, she LOVES her walks, so I don't want to stop. Next week we start 10 minute walks, so we'll see how that goes. I am just hoping this surgery will take a little longer to recover from since they took cartilage out of her knee. Like I mentioned before, something I read said to expect the dog to limp for 4-6 weeks and yesterday was the end of week 3. Thinking about that makes me feel a little better. We're only halfway through that time frame and she has made vast improvements. I can only hope it will continue. Send positive thoughts our way for the next few weeks and I'll try to update when I can!

1 Week Post-Op

It's technically been a week and 3 days since surgery, but who's counting? In my last post I was concerned that Heidi was mostly holding up her leg and walking on 3 legs, but that has gotten much better since then. She now always walks on all fours. She still has a limp, but I read on some vet website that the limping was expected for 4-6 weeks, so that made me feel better. Several days ago, she was using her leg a good bit, but when standing still, she would just barely touch it to the ground, oftentimes just resting the top of her foot on the ground with the toes curled under, if you can picture that. Today I was taking a good look at her and realized she is now putting some weight on that foot when standing still, so that's a definite improvement. She is also VERY energetic. For probably the first 3 days she was very quiet, but now she is back to her old self and then some! It's hard to keep her quiet. She can be quite wild at times, especially when we come home from work. I just have to sit on the floor and pet her to make her settle. Otherwise she would be running around in circles and that's not good! We carried her up and down the steps for probably the first week, but have stopped now. It's not like her bone is healing, she just had a piece of cartilage removed. It's HARD for me to carry a 74lb dog up and down the stairs safely. I mean, that's more than half my weight! I was always scared I would fall, so I'm glad we decided that wasn't necessary. Her stitches come out sometime between Monday and Thursday. I like to wait closer to the 14 day mark, but if she starts messing with them before then, I'll take them out earlier in the 10-14 day range. Other than that, I don't have much to say. She's doing well, and I hope she will continue to limp less and less and gain back that muscle mass in her left leg. Poor thing is so scrawny compared to her "Hulk"-like right leg. I'll try to snap a picture at some point because it's funny. Anywho, I'm off to enjoy this gorgeous day- 71 and sunny! I'll take it! Check back soon for an update :)

Postop Day 2

Heidi finally got home around 7 yesterday evening. I think it's safe to say we were both very excited to see each other (I hadn't seen her since Wednesday morning before school). She was still pretty groggy from the meds and slept most of the evening. I was disappointed to see her mostly holding up her operative leg. I think it's totally expected, but after all of her other surgeries she has used her leg from the get go so I wasn't really expecting it for her. I will say she does use the leg a little if we force her to go slow. Especially if she's out on the grass or soft ground. This morning we got a wake-up call from the vet school at 7am... on a Saturday! They wanted to see how Heidi was doing. I was like, "well, she's still sleeping so I don't really know yet!" After that, we got up and went outside and ate breakfast. While outside, Heidi used her leg more than she did last night, so that was reassuring. She is on the same medications as before: tramadol and Rimadyl for pain and inflammation. She still seems pretty exhausted, as she has been sleeping all morning. We have blocked off the same area as before to keep her quiet. Her recovery is much shorter with this surgery, but we still want to do it right. Her mobility is supposed to be really restricted for the first 2 weeks, then after that she can begin short walks, increasing in length for the next 2-4 weeks. After that (fingers crossed) she will be back to normal. I will try to do frequent updates, especially to document the progression of her limp so check back in a few days!

Surgery #4

The hubs had to take Heidi to NC State yesterday for her appointment without me because I had clinical (I'm in nursing school for those of you who don't know) and I could not miss it. It KILLED me not to be there. I sent him on his way yesterday morning with a list- like an actual sheet of paper.. ok THREE sheets of paper- of questions and a list of meds Heidi is on currently. Seriously, I am probably the craziest dog-mom they've ever seen, but whatevs! I love my girl. They did X-rays and decided there was no infection!!! Best. news. ever. So she's in surgery today for a Meniscectomy (meniscus removal). She should actually be out by now, but we haven't heard from them yet. No news is good news, right? I'm so anxious to hear how my babe is doing, but I'm trying to be patient. More to come about how it went in a day or so. We pick her up tomorrow!!!

Quick Update

In the time between now and the last post, I made an appointment for Heidi on September 4th at the NCSU Vet School. I had to take Heidi to our local vet a couple of weeks ago because she began getting a swollen, red lump on her incision line just like last time. It was lower on the incision line than before, but they did a culture and it was infected. She was on antibiotics and it cleared up quickly, but the vet we spoke with at NC State is afraid these abscesses are being caused by an infection on the inside. I hope and pray they're wrong. Before that, though, as I posted before she was having the lameness and clicking associated with a meniscal tear, so strangely enough, that is what I'm hoping for. If it is indeed an infection of the implant, they will have to remove the remaining hardware, which is a porous titanium wedge (that her bone has now grown INTO). I don't really know what they do then to stabilize the knee/leg and apparently the recovery is AWFUL. So yeah, I'm really hoping that's not it. Well, I just wanted to do a follow-up post to let you know the latest, and you can expect another post in the near future in regards to her appointment on the 4th! Until then, send happy thoughts our way!

Torn... literally... again...

My poor Heidi girl can't catch a break.  A couple of weeks ago she began limping AGAIN.  It was minor and would kind of come and go, so honestly, the hubs and I tried to ignore it.  We decided no walks, just outside to potty, and that was it.  We were so hoping it was just a fluke (even though in the back of my mind I knew it wasn't.)  A couple of days ago, for the first time, I heard her knee popping.  I could just rip my hair out; I feel so defeated.  We seriously have tried to do everything right.  No more dog park.  No more rough play.  No more running.  Just controlled walks and lots of love.  I don't even know what brought this along- which is the worst part.  Just one night, she got out of her bed and was barely using her left back leg.  If you're not familiar with the progression of these knee injuries, often the next thing to go after a CCL tear is the meniscus.  The telltale sign is the knee click (popping). 

I need to call the vet school and make an appointment for her to be seen, but I already know what they will say- another knee surgery.  Her FOURTH knee surgery (third on that knee).  So I've put it off.  I will do it tomorrow.  Ugh. 

I know I'm getting ahead of myself, as I don't have all of the options or facts, but I'm really torn about the meniscus repair/removal surgery.  For those of you who don't know, the meniscus is a cartilaginous structure inside the knee.  It cushions the knee and helps provide stability to the joint.  With a torn meniscus it causes pain and instability... and leads to arthritis.  Without it, I imagine it may eventually cause pain and instability due to... dun dun dun... arthritis.  Well, maybe they'll only take out the damaged part of the meniscus.  But then does that leave her susceptible (or maybe even more susceptible) to future tears, leading to future surgeries?  I need to write these questions down to ask her doctor. 

I read somewhere that surgeons only think of the short-term.  If she has this surgery, she will be fixed.  But is it a permanent fix or just temporary?  In another 6 months will we be at this same place again?  My dog is only 3 years old!  I want to know where I can realistically expect Heidi to be when she's 10.  By God this dog will live past 10!  She's a shelter dog for Heaven's sake... a MUTT!  Aren't they supposed to be the best dogs?  I have a minor in genetics... a broader gene pool is supposed to provide enough variance to prevent genetic conditions, so WHY does my dog have a "genetic" degenerative joint condition????

Alright, time to put on my big girl panties.  I apologize for my pity party.  It's not really for me.  It's for Heidi.  She is the best dog.  She does not deserve any of this.  But I guess we'll take the hand we're dealt and do what we have to do.   That is all for now- I'll keep you all posted!

Side note:  If anyone reading this has had a dog with a torn meniscus, I would love to hear your story.  I haven't been able to find much online.

Some good news for a change :)

Earlier this week, the vet school called to let us know that they would be calling in an antibiotic for Heidi because some bacteria grew on her cultures.  I was very excited to learn that it only grew on the tissue and wire cultures.  No bacteria on the pin!!!!  That is what we were hoping for, because the pin actually entered the bone, and bone infections can be reeeeeeally bad.  The wire and the soft tissue, of course, were on the outside of the bone.  I am really hoping and praying that this last surgery and antibiotic fixes all of Heidi's problems, and she can get back to being a (fairly) normal dog!

Can someone send some GOOD luck our way!?!?

Well, the inevitable has happened.  The lump on Heidi's knee returned and we just brought her home from the vet school after having her THIRD surgery.  Mind you, my poor girl is not even 3 years old yet!  As the vet suspected, the irritation being caused by the wire from her MMP surgery was not a one time fluke.  We went to the lake for Memorial Day and Heidi went for a swim (her first time actually swimming willingly!) and the knot reappeared.  I called the vet school on Tuesday and they got her in today, Friday.  It was a fairly simple procedure- basically they removed the wire and the pin from the MMP surgery, but left the porous titanium wedge in place as there was no sign it was infected.  The pin and wire aren't actually needed now that her leg has healed, however it is usually not necessary to go back in and remove them because they typically don't cause problems.  Of course, that's not the case for our girl.  They took a tissue sample for culture and also cultured the wire and the pin.  We should know by Tuesday or Wednesday whether or not there's an infection brewing in there and she may need antibiotics.  We are hoping and praying that if it is an infection it's just in the tissue and not in the bone/wedge.  The vet said usually if an implant is infected, the bone sort of separates from the implant which can be seen in an X-ray or during surgery.  Hers did not have any type of space as far as they can tell, so that's a point on the positive side.  We do NOT want to have to remove the wedge so hopefully all of you Heidi fans can send any spare luck our way. 

Heidi is doing great since surgery.  They actually let me pick her up today, which was surprising because I was initially told she'd have to stay overnight.  I was thrilled to say the least (until I had to swipe the plastic, ouch!).  Right now, she is sleeping on her bed beside me.  They said she may limp because her leg would probably be a little painful, but in typical Heidi fashion, she is exceeding the expectations and she isn't limping at all!  I have Tramadol and Rimadyl to give her for a few days to help with pain and inflammation, but so far she's doing really really well.  Just groggy and a little nervous/paranoid acting. 

As always, I'll keep you updated if anything changes and will let you know the results of the cultures.  In the mean time please, please, please cross your fingers for good news next week!

Say it ain't so...

Well, it has been a long time since I've updated the blog, but we've had some changes since my last post.  In early January we let Heidi play out in a yard leash-free for the first time since surgery.  She probably overdid it a little, and the next day we noticed a little swollen lump on her incision line (her knee that was done in July- the MMP surgery).  It was kind of hard, kind of squishy- weird I know.  After a few days of rest, the swelling went down and we went along our business.  A few more times we let Heidi have some off leash activity and each time, this little knot would appear the next day.  More recently, I've noticed this knot is always there.  It swells with excessive activity, but never goes completely away.  Finally, maybe the end of February we took her to our local vet to get it checked out.  They did not think it was anything too serious, but were afraid to do anything to it since they had not performed the surgery, and recommended we see the doctor who did the surgery.  So after much deliberation, Alex and I made the appointment.  Last Thursday night I came home from clinical and the knot/lump had burst (no idea how or why).  It was bleeding slightly, but that was about it- no pus or yucky discharge.  Luckily, our vet appointment was set for the following Monday (yesterday) so over the weekend I kept it covered with gauze and tape and flushed it daily with sterile saline.

Fast-forward to yesterday, the day of the appointment at the vet school.  I took off work and to Raleigh we went.  We had X-rays and obtained a culture of the wound.  The vets think the knot was probably caused by the tiny wire that held the implant in place.  (If you look back at one of my previous posts, probably around July of 2012, there are X-rays of the procedure she had and you can see what wire I'm talking about).  Apparently some dogs are super sensitive and the tiny ends of the wire can irritate the tissue in that area.  This irritated, inflamed area then probably developed an infection- we will know more about that when the culture comes back (by Friday).  They started her on a broad spectrum antibiotic, Clindamycin 300 mg every 12 hours, and once they find out if it is a bacterial infection and what type, they will prescribe her something more specific.  In the mean time I am cleaning her wound with a chlorohexidine solution they gave me, applying triple antibiotic ointment, and covering it with a gauze bandage.  I chose to go this route for now, until the culture comes back.  They really encouraged me to do the surgery to remove the wire, but I wanted to see what "bug" was in her, causing this mess before making that decision.  There is a small chance it could just be an inflammatory response with no infection, but they seem to think this is unlikely.  Our greatest risk here is that the actual implant (wedge shaped foam-like piece between 2 pieces of her bone) or her bone could become infected.  That is a very serious problem and would likely require removal of all of the hardware in her leg, which would leave her at a high risk for injury.  That would require another 8 weeks of total confinement to allow the empty space to fill with bone and would be very very tough on both Heidi and us.  So we of course are trying to avoid that at all cost, but I also just want to make sure there is an infection in the first place before jumping to more surgery. 

My poor girl has been through it, but she is a trooper.  Just to add my two cents, if I could do this all over again with her second knee, I would've done the TTO procedure like we did with the first knee.  Knowing what I know now, I think if you do get in a situation where the implant is infected, it is MUCH easier to remove the hardware and much less traumatic to the poor pup who endures the procedure with the TTO. Yeah, the MMP was a few hundred dollars cheaper and she was under anesthesia for a shorter amount of time, but the possible complications seem less extreme with the TTO.  Just thought I'd put that out there in case anyone is toying with a decision between those two surgical procedures.  As always, I will keep you guys updated as often as I can.  Should know more by Friday.  In the mean time, keep us in your thoughts!