6 weeks post-op

Well today we are 6 weeks post-op!  Sorry I missed our 5 week check-in... I just started school this week and was distracted by all the preparations of being a student again, but that's a story for another day.  Today we actually begin going on 20 minute walks.  Heidi has thoroughly enjoyed her 10 minute walks and will love our even longer ones I'm sure.  As far as her limp goes, it's only barely noticeable, yay!  She still does not evenly distribute her weight between her two back legs while standing still, but slowly she seems to be balancing it out more and more.  I think these rehab walks are helping with that because there was such a difference in muscle mass between the two legs and now we're beginning to build that back up in her left.  Surely strengthening the operative leg makes it feel more stable and trustworthy (for lack of better word).

So needless to say, Heidi is doing great.  I can't wait for her to be able to be "normal" again!  But we'll take it slow and ease her into more and more activity.  I cannot remember if I told you guys, but dogs who have cruciate ligament tears are more prone to meniscus tears.  The meniscus is a  cartilaginous cushion (if you will) within the knee joint.  The chance of a meniscus tear is not as great as the chance of tearing the second ACL after the first tear though... I think the doctors quoted us a 10-15% chance of meniscal tear post ACL surgery.  Much better odds than the 60+ percent we were warned of a second cruciate tear after the first.  So we're hoping we're in the majority and don't have to worry about any more tears!

Oh one other thing.  I did notice earlier this week Heidi had a loop of suture coming out of her incision site.  I was afraid that was happening because she kept licking her knee and it looked weird... almost the way an ingrown hair looks.  These sutures aren't the outer sutures that I removed after 14 days, but rather the internal sutures probably used to stitch up the muscle and other tissue under the skin.  These are supposed to dissolve on their own, but I know from experience working with vets, sometimes it takes a while.  So they appear to be working their way out.  I cut what I could because I was not able to pull them out.  They must be connected to other pieces, but I wanted to let you know this happened, so if it were to happen to you, you don't freak out!  I think it's normal (I did not consult a vet, but I've seen this before) so I'm not worried. 

Anywho, I just wanted to give you a quick update!  Enjoy your weekend!

Rehab Walks in Full Swing!

Well, we reached the 4 week post-op mark on Friday and began our walks.  Needless to say, Heidi was thrilled to venture beyond the "potty area".  This week, she gets two 5 minute walks every day.  It doesn't sound like much, but it makes a world of difference for her.  Gives her a chance to briefly release some of that pent up energy.  (She has a LOT of it!)

I would like to note that her limp is continuing to get better.  It's much much less noticeable when she walks- maybe just a tiny hitch in her step- although she still doesn't put full weight on it when standing still.  I do think that has improved a little since my last post, however. 

As far as aesthetics go, her knee looks all kinds of funky.  The wedge of bone they pushed out to make room for the titanium implant looks really creepy and uncomfortable, but obviously it's working because she continues to improve each week.  I'll just have to get over the bumpy knee.  I need to try to get a picture of it... I promise, it's really weird and creepy... more so when she is walking.  Oh well, whatever works!  Her other knee looks very different.  It's still bulkier than a "normal" knee, but in a different slightly less creepy way.

At this moment, Heidi is laying with head against the base of the couch couch looking under it (probably at a toy) and whining with her tail thumping against the floor.  Sorry neighbors :-/  Obviously we haven't burned enough energy today.  We are looking forward to our 10 minute walks next week! Until then, have a great week/weekend and I'll update again soon!

A Little Past 3 weeks

All smiles

This post is going to be boring, but I want to try to post every week for those people who are following along because they find themselves in the same situation we're in.  Heidi is doing great!  Nothing new to report, really.  I will say I think the past couple of days I've actually noticed a difference in her limp!  When she walks it's really not too noticeable, but she does still bear less weight on her most recently surgerized (left) leg when she's just standing still.  It is totally possible this is a result of the reduced muscle mass in that leg and not so much that she's in pain (I'm hoping that is the case at least).  I was checking out her legs this evening as she was snuggling in my lap and it is crazy how big her calf muscle is on her right leg compared to her left.  There's also a pretty noticeable difference in her thighs/glutes, too (ps. I have no idea if dogs muscles are named the same things as humans so use your imagination).  I can't wait to build those back up!  Starting Saturday, she gets to begin her rehab walks :)  We'll start with 5 minute walks twice a day, which will be a real treat to Heidi! 

My only other concern is that she is becoming more and more wild. Obviously her leg is feeling much better because she is reverting back to her wild-woman ways.  We've started giving her Tramadol less than 12 hours apart.  We still only give it twice a day, but I give it when she eats breakfast around 8, then again around dinner time at 5:30ish.  Last time, we began giving the Tramadol three times a day as you may remember, but I'm sort of against over-medicating and this seems to do the trick.

Well, that's enough for now, see ya again in about a week!

It's been 2 weeks

Just laying in Mom's lap

Well, we're a little past 2 weeks post-op at this point, and things are still going great.  Nothing much to report, but I do want to say Heidi is still limping.  I think it's getting better but I see her every day so it's hard to tell.  It's definitely better than when she first came home, though.  So I think slowly it is getting better.  I was starting to freak out a little (as I knew I would) because she still had a pretty noticeable limp, but I looked back in my posts from last time, and found that at 2 and a half weeks post-op I reported that she still had a bit of a limp, so I think we're on track.  Made me feel a lot better at least!  Oh, I did take out her stitches this past Wednesday.  Everything looked good and her incision seems to be healing nicely.  She was a little more difficult this time, but I put Alex at her head with a spoonful of peanut butter, while I clipped and pulled out the stitches and that worked like a charm. 

Well we're halfway through the first 4 weeks which is fabulous!  Heidi is pretty antsy at times, but she's been a good girl.  Her grandparents came to visit her yesterday and she was SO thrilled!  As I've probably mentioned before, they are her favorite people.  And I guess that's all I've got!  Except for a few pictures, of course!

Family snuggle time!

Dad bought her a new bone

Playing dress-up in Mom's necklace

6 Days Post-op

I just wanted to update very quickly before going to bed.  No major changes for Miss Heidi in the last few days.  She is still doing very well.  One thing to note, I haven't noticed nearly as much swelling as with the last surgery.  Some of you may remember her "jiggly cankle" as I liked to call it.  There has been almost no jiggly swelling this time.  Maybe it's because the surgery was slightly less invasive?  Who knows.  I have noticed it's much easier for her to get up and down.  The first couple of days, just laying down from standing and standing from laying down was quite the task.  Lots of funky positioning and balancing.  Now, she uses her operative leg much more making her more stable.  She also seems to be walking with slightly less of a limp, although it's hard to judge because I see her daily.  We ended her main pain medicine, tramadol, a couple of days back and got to increase the trazodone (her "calming" drug), but she's MUCH more active.  She is a maniac when I get home from work.  Forget tail wagging... it's more like full body wagging... for like 5 whole minutes.  But I sit down with her and we snuggle and she gets it all out!  Not gonna lie, that's probably my favorite part of the day.  Makes you feel good to be soooo missed!  Other than that, not much to report, thank goodness!  I'm going to take her out one last time then hit the sack.  Oh and tomorrow is Friday, so you know it's gotta be a good day! 

Post-op: Day 3 (again)

Well, I'm glad to report I really have nothing to report!  Heidi is doing really well so far.  She sleeps a lot (thanks to some wonderful medications!) and she loves to snuggle with Alex and I.  She's eating well and all's normal when it comes to bodily functions, so I'd say we're doing great!  The one thing I look back in my blog and wish I had talked more about is her limping.  I don't remember exactly how it progressed and really should've talked more about it because, of course, this time I have a feeling I'll be paranoid she's not doing as well as before, when in actuality, I probably just don't remember!  So for the sake of others in our same situation, I'll try to note the status of her limp in all my posts.  However, it's important to note every dog's recovery will be different so if you're also going through this, don't freak out if your dog's progression doesn't exactly mirror Heidi's.  From day 1 post op, she's been using her leg.  Not to it's full potential, obviously, but she does bear some weight.  I would say today she actually puts a little more weight on it than the past two days, although if she gets going too fast (bad dog!) she will skip that leg every few steps.  I took her outside an hour or so ago and we saw another dog. It was all I could do to keep her calm so I now know I need to keep her from seeing other dogs when outside. And I'll tell you what I really love about this whole thing... carrying my 70 lb dog up and down the stairs for potty breaks!  And in this heat!!! I'll really miss that the most when this is all over ;-)  Well, that's all for now.  I'll post again in a day or two.  In the mean time, enjoy some precious (if I do say so myself!) pics of "the Hiney"!  [*Just FYI, our niece used to call her Hiney before she could pronounce her name and it stuck! So that's one of her many silly nicknames]

First day post-op snuggling in mom's lap <3

Rear view: slight swelling and muscle atrophy and of course a POODLE HAIRCUT!

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 :)