April 30, 2009, our new reality

Winston is finally home and we don't see any surgeries in his immediate future. We're just working on trying to get him healthy again after his knee infection. He's here with his pegleg bandage.

He finds it hard to walk with because he can't bend the knee enough to keep from dragging it behind him. That looks awful and really uncomfortable. I try to use the sling to help him out, but that doesn't seem to work very well either because the only way for me to get the leg up off the ground is to totally lift his hind-end and he hates that.

I'm trying to feel his toes. I can barely even find his toes, and the only part of them that I can feel is the horny calloused bottoms of the two middle toes. Are they cold? It's hard for me to tell because I am usually cold these days so when my cold fingers are feeling the rough part of the two toes, I don't feel much difference. It doesn't feel warm to me. Is that cold? Or am I just "normal cold" and so is Winston. I (of course) worry about this, but decide that since they don't feel a lot different from my finger temperature that they're probably fine -- my fingers are fine and not ready to fall off.

He's eating today. He ate about a can and a half (those 5.5 oz Mighty Dog cans) of food for breakfast, so at lunchtime I thought I'd add a little kibble to it. I added about a quarter of a cup of kibble to a can of food and he ate it, but wouldn't eat any more. He did the same at dinner time, but then before bed he ate another can of food.

April 29, 2009, 12 weeks post-op

We dropped Winston off at AMVS again for what we hope is his last surgery for the infection in his knee joint. Later in the morning Dr. Trousdale called to say that they were unable to push fluid through the joint (he told me this is a sign of healing) and that he trimmed away the granulating tissue on the edges of the wound so that he had a good bleeding edge to sew together. After a wound has been open this long, I guess there are other concerns about whether all the layers will heal to each other and whether the wound will stay closed. He seemed pretty concerned, but since I don't have any experience with any of this, it's hard for me to really understand all that could happen. All I know is that if my vet is concerned, I should be too.

He said that the knee is still very unstable and that's probably how it is going to stay, but our first priority right now is to get him out of the woods with the infection before we worry about next steps. They'll be sending him home with antibiotics for 2 more weeks, so that he'll be on them for a full month, then we have to wait another two weeks to see if the infection comes back. At that time, we'll see where we're at.

We picked him up this evening and took him home with a "pegleg" bandage on his leg. It fully covered his leg from the tips of his toes (which did just peek out from the end) all the way up to cover most of his thigh. We got to watch Dr. Trousdale put it on, and I thought the process was pretty interesting. They want us to try and keep the bandage on for at least 3 days, and hopefully 5, but said that we could remove it if it got wet or really started to bunch up behind his knee. We're also supposed to feel his toes a few times a day and if they feel cold, we're supposed to remove the bandage. Don paid the final bill for today's care.

April 28, 2009, 12 weeks post-op

We picked Winston up this afternoon from AMVS. He's got a couple of extra meds to take because of the stomach irritation caused by the bandage. They said that he wasn't interested in food for them. Other than that he seems happier. I am resigned to the fact that this is going to hurt us for awhile financially, so I put Saturday through today's bill up to this point on my credit card.

He's not groggy from surgery and that's kind of a nice treat for us. He's got a huge satellite dish e-collar on when they bring him out and you can tell he just hates it. We get him loaded into the car with it and get him home. He pretty much just lays down with his head flat since he can't stand to have it bobbing around on the top of his head.

I went to find some food and took the e-collar off while I tried tempting him with it. He's willing to eat and eats an entire (tuna-sized) can of dog food. I opened a second one hoping that he'd eat that one too, but it's too much after not eating for so long. I'll try again later. I brought a crazy-creek chair into his pen so that I could sit in there and read next to him so he didn't have to have the e-collar on for awhile. He seemed happier. When I left, I put it back on him. This is the new reality for him.

I tried more food again later that night and he ate another whole can -- HOORAY!

April 27, 2009, 1 day short of 12 wks post-op, knee unstable again

We dropped Winston off at AMVS at 7:00am for his next surgery. I guess the silver lining for his lack of interest in food is that I don't have to feel guilty that he's hungry when we drop him off. Of course I still feel bad that he's going through this. Hopefully things will go well and they'll be able to close the wound today.

Winston is not normally a licker or a chewer on himself. We got lucky that he never did anything to himself with either of his tightrope surgeries. Towards the end of his 2-week e-collar stint on the second surgery, I watched him (with his donut e-collar on) reach around and nip at an itch on his leg "good" (left leg) right where the incision scar was. It was at that point that I realized that if he had been determined to get at his incisions, he could have done so despite having his donut on. My advice is to get the satellite dish style of e-collar.

They called in the afternoon to say that they were about to do his surgery and found him with no bandages on his leg. After looking around and asking around if someone had removed them, they figured that he'd eaten them. They took x-rays to confirm this (apparently there is something in the bandages that shows up on an x-ray) and luckily everything was still in his stomach so they'd be able to send a scope down his esophagus to pull them back out. There would be no charge for this and there would also be no charge for him to stay overnight at the hospital so they could watch him.

This is also a lesson to all of us... even when we think our dog is trustworthy (look what he's been through so far without ever doing anything like this), DON'T trust him. I have no doubt that AMVS will never trust another dog again and they'll ask that you bring your e-collar back with you each time. Since we were doing almost daily surgeries, I'd forgotten to bring it with me one time, and they'd told me that they had spares in the back. I got to the point where I just figured they would put one on him and stopped carrying it back and forth and Winston often had visitors while he was there, so they probably got to the point of trusting him since he was often being watched. That will teach us! Anyway, please don't hold it against them or think that they didn't provide excellent care, they did and they still do.

They called again when they finished his surgery to say that they'd been able to remove the bandage from his stomach and that they were still getting some gunk out of the fluid that they were flushing through his knee. They also said that they were still able to flush all 3 liters of fluid through the joint. I didn't understand the significance of this, but they explained that if it had healed enough, the fluid would be blocked from going into the joint, and would sort of "back up" or be really hard to push. Kind of like if you stuck a syringe into a piece of wood and then tried to push the plunger down. Either the fluid in the syringe would cause the needle to back out of the wood, or you wouldn't be able to push the plunger down at all. I guess that's what they're looking for when they determine if the infection has healed enough. So... we are going to skip surgery tomorrow, but we go get him then since they're keeping him overnight. And then we take him back again on Wednesday where hopefully they'll be able to finally close the wound.

Then... they had to tell us that today the joint wasn't stable anymore. I didn't know what that meant for long term prognosis. I asked if there was a chance that once his wound was closed up that the scar tissue would re-develop and hold everything together. I think I was grasping at straws. They had to tell me that there is a very small chance that will happen, but it's very unlikely that it will improve beyond what it is today.

April 26, 2009, 11.75 weeks post-op

The swelling is going down in Winston's leg. You can still see fluid around his hock in the top picture. The second picture shows where they removed the "big" toggle along with the lap sponge bandage doing it's thing. Notice how light colored the scar from the "middle incision" is now. The bottom picture shows how swollen his thigh still is, with the funny wrinkles across it where the skin is being pulled. It's hard to see in these pictures, but if you look closely, they show the little web of rubber bands holding the bandage in place.  Click on the picture to blow it up huge.

I tried him on food. He wasn't really that interested, but when I opened up one of those small cans of Mighty Dog and offered him a chunk of food covered in sauce he at least took it from me. YEAH!!! He took one more piece and then he was done. Well... ok, "sort of yeah". I try to feed him a couple of pieces of the canned food every couple of hours. He's not interested in more than that, but still... it's an improvement. He will also drink a little bit when I offer him water. I have to offer it to him because he does not stand up unless he has to go outside to pee.

No more accidents since the other day.

April 25, 2009, 11.75 weeks post-op

Winston definitely had a better attitude this morning. Not even close to being back to himself, but he no longer seemed like he was on death's doorstep. He wanted a little water when I offered it to him.

We took Winston to AMVS at 10:00 as we'd arranged yesterday, and Dr. Trousdale called after the surgery and said that it went well even though he still got some chunkiness out when he flushed the joint. We arranged to pick him up later in the afternoon, and we get to keep him home until Monday morning. That way I can try to get him to eat something.

When we picked him up, he was again very groggy and dopey from the anesthesia. He went straight to sleep once we got him home. I woke him up around dinnertime and again before bed for pills and to try and tempt him with food. I had to shove the pill pockets into the back of his throat, but at least he'd swallow them, and he didn't want food at dinner, but ate a few pieces of food before bed. I tried sleeping on a thermarest on the floor next to his pen, but every time he moved, I'd wake up and every time I moved, the thermarest would make a noise, so he would wake up. I finally decided that it was best that I was on the couch at the top of the stairs afterall. He woke up once during the night and had to go out, but then slept again until morning.

April 24, 2009, 11.5 weeks post-op

I actually slept last night. In my own bed. I think that's the first time since December? It was a relief and I have a more hopeful attitude today. Part of it is from getting sleep and part of it is because they found a reason for Winston to be so miserable and we're working toward fixing it. I always feel better doing something about a problem than waiting for some outside force to intervene. I'll admit to being a bit of a control freak.

Josie is wondering what's going on, but now when Winston is gone, she's not as worried. She's never known anything but this. She is very kind to him and also protective. That's a little funny when you think about it. He is almost twice her size, but she's the one who watches out for him.

Dr. Trousdale with AMVS called after Winston's surgery. He said that Winston's attitude had picked up a bit this morning, so the surgery yesterday had made a difference. Today they flushed another 3 liters of fluid through his knee joint and they're still getting chunks of gunkyness (can't think of a better way to describe it) out so even though they'll let him go home with us tonight, they want him back again tomorrow morning so that they can flush it out again.

Dr. Trousdale is pretty detailed about what we should expect when we come to get him, and what to expect overnight, and he will be the one taking care of Winston over the weekend. He hopes that tomorrow goes well enough that we can skip Sunday and then if all goes well, we can close the wound on Monday.

He said to expect the lap sponges to be white (or close to white) when we pick him up and by morning they'll be dark brown colored from the fluid that they're absorbing. Winston is still on antibiotics and pain pills, so we'll have to keep giving them and if he'll eat, he can eat tonight but nothing in the morning since he's going to have more surgery.

After work I ran to PetsMart and got a couple of packages of Greenies Pill Pockets -- something I discovered during a Josie vet visit. I also searched around for some kind of small canned dog food so hopefully I wouldn't have to refrigerate it between attempts to feed Winston. The temperature of the canned dog food before seemed to turn him off. I finally settled on some tuna-sized cans of Mighty Dog "chunks in gravy". It was a mixed box of beef, chicken and turkey. Hopefully Winston will think it's tasty.

We picked Winston up about 6pm and he was still pretty groggy from his surgery earlier in the day. Don put the bill up to today on his credit card. The bandage was a little damp looking but not dark brown. I knew what to expect as far as the description of the bandage, but when I pictured the bandage in my head, it wasn't the same as what I saw. It's HUGE and it was held in place by rubber bands that were stitched into the skin of his leg. My poor boy.

I checked on him later only to find that he had peed on his bed and he was still laying in it. How depressing. I hope that it's because he's still not fully in control because of surgery rather than because he just doesn't care enough about what happens to him. I got him moved over to the other bed and I sopped it up with an old "dog towel". Luckily the fabric covering that bed is still pretty water resistant and it had been covered with an old blanket that had taken most of the hit. I got all of that into the washer with about a cup of white vinegar in the bleach dispenser along with detergent in the detergent dispenser. I re-covered the bed in more dog towels and hoped for the best since he's now on his orthopedic bed that has a fake fleece cover. That'll soak up some urine!

April 23, 2009, infection and tightrope removed

I still try to offer Winston food but today even if I put it in his mouth he tries to spit it out. I'm closing his mouth and trying to make him swallow it, but I don't know how long I'll be able to standing doing that when he's so miserable.

AMVS called and the lab culture came back positive, so there's an infection in the joint. They want him in right away so that they can do surgery to flush the infection from the joint. I called Don and asked him to come home and help me load him up. He came right home and we took him to AMVS but I had to ask for an estimate on how much this was going to cost. They said that an infection has to be treated as an open wound (I didn't really understand what that meant at the time) and that the whole situation is fluid because they don't really know what they'll find once they go into the wound. They gave us what they thought was the high end of about $1800 for the wound treatment through Saturday. I don't want to go into debt, but Don said that he would pay for the treatment (I guess I should add that even though we've been married forever and have joint accounts, we pretty much manage our money separately). We agreed to the wound treatment and they took Winston off to surgery and said that they'd be keeping him overnight.

AMVS called after they finished his surgery and said that they had to remove the Tightrope implant because the bacteria clings to the fiber tape and the infection couldn't be controlled if it was left in place. They had to make a small incision on the inside of his leg to remove the large toggle used on the lower leg bone. That toggle is also where the knots are in the fiber tape. They left the small toggle used on the upper leg alone because they were able to fish the fiber tape out of it and it would cause more damage to make another incision to get out a tiny piece of metal that wouldn't cause any issues (apparently bacteria doesn't adhere to metal). They explained the surgery as basically sticking a big bore needle down into the joint between the bones and flushing 3 liters of fluid through the joint to remove the pus and "chunks" and other infected gunk. Then instead of closing the wound, they pack it with lap sponge bandages because bacteria likes a wet environment so the bandages wick the moisture out of the wound.

I was very concerned to hear that they had to remove the implant because to me that meant that we just reversed the Tightrope surgery and we were back to square one. I asked more questions about this and they explained that he had been far enough along in the healing process that the fiber tape was loose and his body had formed scar tissue that was supporting the joint all on its own. They said that the joint was still stable so at this point, they were hopeful that it would remain that way.

They want to keep him overnight and do another surgery tomorrow to flush the wound again. Because they're actually going into the joint itself, they have to use general anesthesia for the surgery.

April 21-22, 2009, on death's doorstep

Tuesday:
Winston is definitely getting worse. He's no longer interested in food at all. He will only eat if I put food in his mouth and try to make him swallow. The antibiotics don't seem to be doing anything for him and the swelling is traveling down his leg. When he stands up to go outside (which isn't all that often now since he doesn't want to drink either) all of the fluid pools around his hock. I feel like I'm watching him die and it's awful. I cry a lot these days. I've mentioned putting him down to Don and he is horrified by the thought. He thinks I'm too quick to go that route. It's killing me to watch Winston suffer so much.

Wednesday:
Winston's leg is now twice the size that it used to be. He's having a hard time going out to go potty because there's so much weight on that side for him to try and lift. It's obvious that his leg is painful and his back is all twisted up trying to hold that leg off the ground. I'm using the sling but hey, he's a boy and it's not all that easy to try and take some of the weight off his back legs when he's got a full bladder, nevermind get it out of the way when he stops to pee. Luckily he's not going out that often, but that makes me worry that he's getting dehydrated. I just worry worry worry all day and all night. This is the hardest thing I've ever gone through and I'm questioning how much longer I can stand it. Am I weak? Maybe.

Don isn't ready to let him go, and I can't take him away from Don if he feels that strongly about it, so I'm just trying to deal with all my feelings.

April 20, 2009, 1 day short of 11 weeks post-op

Winston seems slightly worse than yesterday. He's got a definite knot directly over where the fiber tape is and the "middle incision" is very dark. Actually his skin all around that area seems darker than usual, so maybe that's bruising?

He didn't eat much for breakfast. I hoped that he'd be hungry after a night without food (normally he would be), so I offered a cup of dry food mixed with a couple of spoonfuls of canned and a little water to squish it up. He might have had half of that.

I called AMVS when they opened at 7 am and was able to get a morning appointment. Don stayed home from work and we both took him to the AMVS since we had to lift him in and out of the car. Getting him in isn't so bad, but we haven't figured out a good way to get him out. I have a spare dog bed back there, so we have been pulling that towards the edge of the hatch so that he's close enough to grab whichever half of him is closer to the edge. Don gets that and lifts him out and I grab the other half as it gets to the edge. There's got to be a better way! Winston feels bad enough that he just lays there and doesn't seem to care what we do to him.

We're using the sling to support his rear legs since he doesn't seem too steady on his left leg and just looks really uncomfortable being on three legs. I worry that he's putting too much stress on that leg since it hasn't been all that long since his first surgery. I'm a worrier anyway, so what else is new?

Up to this point, Don had been too busy (he's self employed) to go with me to AMVS. I had mentioned more than once to him that they truly seemed to care about Winston and I think Don was a little skeptical. I think he started to become a believer during this visit.

Dr. Trousdale was the first to see us. He's got a Dogue de Bordeaux (think Turner and Hooch) himself, so he loves mastiffs, and he hated seeing Winston feel so bad. He did the initial exam and then Dr. Duerr joined us. They each moved his leg through a whole range of motions and said that the knee felt stable and we were possibly looking at a soft tissue injury. They thought the x-rays that I'd brought with me looked good as far as the knee was concerned, but the hip in the x-ray looked bad, so they wanted to take another one of his hip just to double-check. They took that and everything looked fine, so it appears that there was some odd mark on the x-ray from the other vet.

Winston's symptoms and the fact that he was losing interest in food worried them, so they decided to take a sample of the fluid in his knee just to check whether there was an infection present. They shaved a small patch of hair and drew out a sample. Under their microscope it looked clear, but they said that wasn't conclusive since there could be a small number of bacteria that could be in one small area of the sample that they put on the slide that didn't happen to make it to the center area of the slide. They wanted to send a sample off to a lab to be cultured since that was the only way to make 100% sure. In the meantime they wanted to start him up on antibiotics just in case. We loaded him up and went home to wait for the lab results. They said the first results would be the next morning when the lab also looked at a sample on a slide, but the culture would take 4-7 days before it displayed (or not) the bacteria growing.

I guess if it's bad news, it will show up earlier and if it's good news they wait the full 7 days?

April 19 2009, 10.75 weeks post-op

Winston seems worse today. His leg is more swollen and he's not that interested in food. I have some canned dog food on hand that I'd gotten in case he wasn't that interested in food after his surgeries. I mixed some of that in with his food and also didn't try to feed him all that much. Normally he eats 3 meals a day and I feed him 2.5 cups of Iams lamb & rice mixed with just a small amount of water for breakfast and lunch and then 2 cups of food mixed with a little water for dinner. Now I only started the day by putting a cup of food in his dish with a couple of spoonfuls of canned food and warm water to squish it up together. He wasn't interested at first, but ended up eating after some encouragement. At lunch he left some food in his dish. By dinner time I thought I'd try just a half cup of dry mixed with the canned. He ate that but didn't want any more straight canned food when I offered it to him. He's still drinking, but seems bothered that he has to drink lying down.

April 17-18 2009, the fall

Winston has been a little lame this week but not too bad. I stopped the Rimadyl on Tuesday (10 weeks post-op), so I guess it's not that surprising. He seemed worse today but we had a snowstorm and I've noticed that he gets sore when the weather changes.

I woke up at midnight by a loud crashing noise. I thought a kitchen cabinet had come off the wall. I wondered if it was a dream until I heard Don say, "Are you ok?" My heart just about stopped and I ran downstairs to find Winston at the bottom of the stairs and Don said that he wouldn't get up. I tried to get him to get up too and he wouldn't move. His right knee was swollen, so we both thought that he'd trashed the repair.

This was bad. We'd just had to pay a large tax bill and didn't have any savings left. I called the animal emergency hospital and told them what happened. I asked them what they would do and they said take x-rays and make him comfortable and that they'd want to wait until Monday and have the surgeon look at him. I knew that we wouldn't get out of there for less than $500. I still had Trammadol left over from both surgeries so I asked them if I could give that to him and take him to my regular vet in the morning for the x-rays. They thought that sounded like a reasonable plan, so I gave him the Trammadol. Don and I both slept on couches downstairs so that we could hear him the minute he moved. He stayed at the bottom of the stairs until very early morning when he stood up on three legs but refused to go up the stairs. He's never been on 3 legs before so he didn't seem to know what to do, or even whether he could trust his left (first surgery leg).

Don and I ended up carrying him (very awkwardly) up the 7 steps to the "lobby" of our house. He needed to go out to go potty, but it was very slow going and he was barely able to hop on three legs, it broke my heart to watch him. I had an awful feeling that we were going to have to put him down after all we'd been through with him. Don kept telling me to just wait until we got him checked out. We were able to get him squeezed into a packed schedule at a nearby vet. Don and I had to lift him into the car and then lift him out again. There's no way he could handle walking on a ramp. The vet's office asked if we could leave him there for the afternoon so that they could take the x-rays and then meet with us afterward.

The vet wasn't familiar with the Tightrope procedure, but said that his x-rays looked ok to her, and that it seemed like it was all soft-tissue damage which she thought was a good thing. We all looked at the x-rays together and since I'd seen the good ones taken at 8 weeks, I was the only one that had something to compare these with. I could see that the toggles were at the ends of the bone tunnels, so I had to agree with the vet. This is my lesson to ask AMVS for copies (on disk) of Winston's x-rays so that I have them on hand to take with me if something like this happens. I asked this vet for copies of the x-rays so that I could take them with me when we saw the surgeon on Monday. We also got more Trammadol to tide us over until we saw the surgeon (I think they only gave us enough for Sunday and Monday to make sure that we got into the surgeon on Monday).

Winston still seems really hurt and wasn't too interested in dinner, but ended up eating most of it after some encouragement. We've got two beds set up (his orthopedic bolster bed from Drs Foster and Smith and also a memory foam bed that we got for $30 at Sam's Club) down in the lobby and we've got baby gates across both stairways. I'm sleeping on the couch at the top of the stairs so that I can hear him get up when he needs to go outside.

March, April 2009, 8-10 weeks post-op

The past 2 weeks have been uneventful. Winston is walking well on his leg and we're up to 35-40 minutes per walk.

I took Winston in for his 8 week post-op visit. They took x-rays and said that the bone has fully healed, and everything looks good (and congratulations!). Hooray again! I got to see the x-rays and Dr. Duerr explained where the bone tunnels were and we could see the toggles, and that nothing had moved since the day of surgery.

We're supposed to keep following our discharge instructions and by week 16 he should be back to normal activities. He and Josie will finally be able to really play!

We can take the baby gates down and let him do the stairs by himself. He still can't get up on a bed (no jumping yet), so we moved the baby gates to the bedroom doorways.

Up to this point Winston has been taking Rimadyl twice a day. I asked if he was going to have to continue that for the rest of his life or if we could stop it at some point. They said that I could try stopping it now and see how he does. They thought it was a good idea to have some on hand just in case we went for a long hike and he was sore afterwards, and if that happened, we could prepare for it and give it to him ahead of time.

I stopped giving him Rimadyl, but within 3 days he was definitely more sore so I gave it to him for another week and then stopped it again at week 10 post-op.