She did it again

Whelp, we were right.  Heidi tore her cranial cruciate ligament (same as ACL in humans) in her left leg, so we've gone to the vet school and just brought her home from her surgery.  I won't go through all the details, as everything was basically the same as with her right leg (which you can find in one of my first posts to this blog if you're new) but there were a few differences this time I'll tell you about.  We skipped going to our local vet this time and went straight to the vet school since we were fairly certain it was a torn ACL.  Our suspicions were correct, so they did X-rays in preparation for surgery.  This time, we actually decided to do a slightly different procedure called MMP (Modified Maquet Procedure).  It's a newer surgery, but it is really just a slight variation of the TTO surgery that Heidi had before.  It's slightly less invasive as they only had to make 1 cut into the bone, unlike the TTO that requires 3 cuts. This also shortens the length of the surgery a bit, making it a little cheaper since you pay for the anesthesia by the hour.  Instead of a titanium plate and screws, this time Heidi's hardware consists of a porous titanium wedge and wire.  The wedge acts as a filler to change the shape of the tibia, and because it's porous, the bone can actually grow in and around it as it's healing.  It's hard to explain how the surgery works, but here's an X-ray I found online so you can at least see what it looks like.



It's kind of hard to explain WHY this procedure is a good solution for a torn ACL, and I'm no expert but I'll try.  So the top bone you see is the femur, and the bottom bone with all the new accessories is the tibia.  The problem when a dog tears their ACL is that the knee loses stability.  The ACL attaches from the femur to the tibia, and without it, the femur can slide down the tibia a little because of it's downward slope, making it uncomfortable/painful for the dog.    The bone modification this surgery does changes the angle of the patellar tendon in relation to the slope of the top of the tibia.  (Just a quick anatomy lesson, the patella is the knee cap and the patellar tendon attaches from the quadriceps to the tibia running over the patella.)  Anyway, the thing to remember is that the angle between the tibial crest and the patellar tendon are of great importance in re-stabilizing the knee (the closer to 90 degrees the better), but I don't exactly know the full mechanics behind that!  I guess that's why the vets make the big bucks!

Anyway, now that I got all the complicated stuff out of the way, I'll talk a little about Heidi.  We picked her up at 8:00 this morning and she's pretty much been sleeping ever since.  I laid down for a nap next to her on the floor when we got home.  We snuggled up and I was able to get a little extra sleep- something I've been lacking this week!  She can walk pretty well and already puts a little weight on her leg just like last time.  Dr. Tuohy said this morning she thought Heidi was feeling "too good" so we will have to make sure she rests it.  As I might have said last time, keeping her quiet for 8 weeks will probably (hopefully) be our biggest challenge!  As with any surgery, there's always a small risk of infection and in her case implant failure, but the incidence of that is low and we will just hope for the best!

I did have a scare with her after we came home from the initial consultation and x-rays, and I should tell you about it because I was totally scared to death and freaking out like a crazy person!  So, she had to be sedated for x-rays- no big deal, she's had them twice before and was fine after both.  Dr. Roe (our surgeon) warned me that she would be a bit groggy probably until the next day and I was prepared for that as we had already been through this twice.  I brought her home and put her in her bed and went about my business.  It was about 6pm and I was starving so I went and grabbed some food then settled in for the night.  I noticed she was a lot more groggy than the last 2 times, but didn't think much of it because isn't that what sedatives do?

 By about 10:30, I was getting ready for bed and was trying to get Heidi up to go out one last time.  It took me FOREVER to wake her and it kind of scared me.  She also felt abnormally cool to the touch.  Then I started noticing she was taking a lot of time between each of her respirations, and being a nursing student I immediately grabbed my stethoscope to listen to her heart beat.  Because of the way she was laying it was kind of hard to hear it, but I thought it was pretty irregular and unusually slow.  So I took her pulse for a minute from her femoral artery, and got 39 beats per minute and it was definitely irregular.  That's when I freaked out.  If I remembered correctly, the average pulse rate for large dogs is 60-100 beats per minute.  Then I counted her respirations for a minute and got 7.  Again lower than what I was pretty sure was normal (maybe 10-20 range?).  I started to panic.  Alex was out of town for the night and I was convinced Heidi was dying.  I called my parents and ultimately decided to call the emergency vet.  I called the one at NCSU since they would have her records there, and they said someone would call me back.  After waiting an hour- the longest hour of my life, might I add- I finally called them again.  The receptionist, Sarah, was so nice and had just spoken with the doctor.  Apparently, one of the drugs they used to sedate her causes decrease in pulse and respirations and respiratory arrhythmia.  Whew!  Such a relief since those were the exact symptoms she was experiencing.  She told me if she was still like that in the morning I should take her to my local emergency vet. 

I felt a lot better and was EXHAUSTED from my anxiety attack so Heidi and I got in bed.  I still wasn't able to sleep well, because it seemed like every hour I would wake up and put my hand on her chest to make sure she was breathing.  Sure enough, when my alarm went off the next morning she popped up and was ready to go!  Here's the take home message from this story.  I should never have children--- imagine what a wreck I would've been if it was a kid?!?!  But who am I kidding... Heidi pretty much is my child and some might say I'm abnormally obsessed with her.  But I'm OK with that!

 I'll upload some pictures later. Time for another puppy snuggle!  This post was ridiculously long- sorry :)