We met with the surgeons again at AMVS. They're happy that he seems to be doing well and there is no sign that the infection has come back. We talk some more about the TPLO and the plan for the future. Don wasn't there for the original description of the TPLO surgery, so they spend a little time with him showing him what they'll do and what to expect for recovery. It sounds similar to the Tightrope, but a bit slower.
Prior to this visit, I've been on the internet again reading about TPLOs again. I've read that the outcome isn't always perfect for a knee that has had a previous surgery. I'm prepared for that. I just hope that he's able to use his leg again (even if not perfectly) so that he doesn't have to be on a leash in his own yard for the rest of his life.
We scheduled the TPLO surgery for next Monday, June 1st.
May 27, 2009
May 23, 2009
May 17-23, 2009, end of the antibiotics
Winston has continued to toe touch since last Friday. Sometimes he actually gets the pad of his foot onto the ground, but he's not putting a lot of weight on it. He's doing so well getting around that we offered to help him up the stairs with the sling but he wants nothing to do with them. I think he remembers falling, so he seems scared of them. I've been leaving the baby gate off of the one that goes upstairs so that Josie has an easier time getting to the door when she needs to. She has taken to spending some time with Winston down in his room, she's so sweet!
We've been spending nearly every afternoon outside in the yard. I got out a couple of our camping cables -- we always keep cables with us when we go camping so that we could keep the dogs securely near us. This breed has no respect for tent zippers, and they will go investigate sounds in the middle of the night, so we learned with our first one that we'd have to keep her on a cable even when she is inside the tent. That's the only time that they're ever tied up and they're always with us, so there's no risk of them running to the end of a cable. Anyway, Winston learned about cables as a puppy and he's fine being on one, so I've been spending time weeding in the yard so that he can be outdoors. Weeding is pretty much a hopeless cause since we've got more weeds than grass, but I'm slowly eliminating certain types of weeds. LOL! I'll keep telling myself that and maybe one day it will come true. It gives me something to do while I'm out with the dogs.
Winston can't be loose in the yard because he wants to play soccer with one of his (now Josie's) balls, and he wants to play with her. Even on a leash he tries to do both and I have to scold him. That's all it takes to stop him, but he's not happy about it.
As kind as Josie is, she is not very careful of him. When she sees him getting attention she will come over and flop down to get some too. They have no sense of personal space, so she often flops right down on his leg and bends the joint sideways and makes him yelp. I have to push her away and tell her to be careful, but she doesn't really "get it".
Winston just came upstairs! It was dinnertime and I just brought them in from the yard and came up to get Josie's dish (the dog food is in the garage so her dish is the farthest away) and she followed me up and after a few seconds hesitation, so did Winston. I just about had a heart attack, but he seemed to do ok. He was very careful and I think going up is easier than down. I quickly put the baby gate up across the top of the stairs so that he doesn't go crashing down. They ate dinner and he spent a nice evening lounging about while we watched some TV. When it was time for him to go out to pee before bed, I got the sling and leash out and attempted to help him down the stairs. That didn't work so well. I seemed to make things worse than if he had done it on his own, and he nearly dragged me down with him. Oh well, the baby gate gets moved to the bottom of that stairway so that he stays in his room until tomorrow. I don't want to have him try it too much at first.
He seems scared of the stairs again. I keep offering to help him up, but as soon as he sees the sling he goes to his bed. hmmmm... finally I just leave the leash on and offer to go up with him (to keep him slow and controlled). Again, he goes to his bed. Ok, he's going to stay in his room today. Later in the evening Don walks him to go potty and next thing I know he's coming up the stairs on the deck. These are steeper and there are 10 steps instead of 7 so this doesn't really make me happy, but I guess they're less scary than the ones inside the house. I don't want him going down these steps though. He gets to spend another evening with us, and this time when it's time for bed, I only use the leash to keep him from going too fast down the stairs. He kind of hippety hops down them mostly on 3 legs but with a dash of toe touch in there somewhere. Doesn't give me a great feeling of comfort, but he's safe at the bottom again for the night.
Today I didn't try the sling, but offered to go up with him on the leash and he actually went up the stairs. He got to spend the day upstairs with me while I worked and then we went outdoors for a few hours and then he came upstairs again for the evening. He's handling himself on the stairs much better with every attempt. I'm not as worried about him anymore.
We ran out of antibiotics on Tuesday. I can't remember if we were supposed to call AMVS when we got to this point? I called them and they said that I should set up an appoint for next week and they'll evaluate him at that time.
Cross our fingers that the infection doesn't come back once all the antibiotics are out of his system.
We've been spending nearly every afternoon outside in the yard. I got out a couple of our camping cables -- we always keep cables with us when we go camping so that we could keep the dogs securely near us. This breed has no respect for tent zippers, and they will go investigate sounds in the middle of the night, so we learned with our first one that we'd have to keep her on a cable even when she is inside the tent. That's the only time that they're ever tied up and they're always with us, so there's no risk of them running to the end of a cable. Anyway, Winston learned about cables as a puppy and he's fine being on one, so I've been spending time weeding in the yard so that he can be outdoors. Weeding is pretty much a hopeless cause since we've got more weeds than grass, but I'm slowly eliminating certain types of weeds. LOL! I'll keep telling myself that and maybe one day it will come true. It gives me something to do while I'm out with the dogs.
Winston can't be loose in the yard because he wants to play soccer with one of his (now Josie's) balls, and he wants to play with her. Even on a leash he tries to do both and I have to scold him. That's all it takes to stop him, but he's not happy about it.
As kind as Josie is, she is not very careful of him. When she sees him getting attention she will come over and flop down to get some too. They have no sense of personal space, so she often flops right down on his leg and bends the joint sideways and makes him yelp. I have to push her away and tell her to be careful, but she doesn't really "get it".
Winston just came upstairs! It was dinnertime and I just brought them in from the yard and came up to get Josie's dish (the dog food is in the garage so her dish is the farthest away) and she followed me up and after a few seconds hesitation, so did Winston. I just about had a heart attack, but he seemed to do ok. He was very careful and I think going up is easier than down. I quickly put the baby gate up across the top of the stairs so that he doesn't go crashing down. They ate dinner and he spent a nice evening lounging about while we watched some TV. When it was time for him to go out to pee before bed, I got the sling and leash out and attempted to help him down the stairs. That didn't work so well. I seemed to make things worse than if he had done it on his own, and he nearly dragged me down with him. Oh well, the baby gate gets moved to the bottom of that stairway so that he stays in his room until tomorrow. I don't want to have him try it too much at first.
He seems scared of the stairs again. I keep offering to help him up, but as soon as he sees the sling he goes to his bed. hmmmm... finally I just leave the leash on and offer to go up with him (to keep him slow and controlled). Again, he goes to his bed. Ok, he's going to stay in his room today. Later in the evening Don walks him to go potty and next thing I know he's coming up the stairs on the deck. These are steeper and there are 10 steps instead of 7 so this doesn't really make me happy, but I guess they're less scary than the ones inside the house. I don't want him going down these steps though. He gets to spend another evening with us, and this time when it's time for bed, I only use the leash to keep him from going too fast down the stairs. He kind of hippety hops down them mostly on 3 legs but with a dash of toe touch in there somewhere. Doesn't give me a great feeling of comfort, but he's safe at the bottom again for the night.
Today I didn't try the sling, but offered to go up with him on the leash and he actually went up the stairs. He got to spend the day upstairs with me while I worked and then we went outdoors for a few hours and then he came upstairs again for the evening. He's handling himself on the stairs much better with every attempt. I'm not as worried about him anymore.
We ran out of antibiotics on Tuesday. I can't remember if we were supposed to call AMVS when we got to this point? I called them and they said that I should set up an appoint for next week and they'll evaluate him at that time.
Cross our fingers that the infection doesn't come back once all the antibiotics are out of his system.
May 16, 2009
May 10-16, 2009, stitches & staples removed
Winston's wound has healed and he doesn't even have scabs left, so once the stitches and staples come out, he can leave the evil e-collar behind -- HOORAY! He hates it every time we put it on, but he's resigned to the fact he has to wear it.He's eating and drinking normally. I've cut him back to 6.5-7 cups of food per day because he's really not getting exercise and I don't want him to get overweight, but I'd like him to regain a little of the weight that he lost while he had the infection. It's a constant juggling act, but I guess everyone goes through that even with a healthy dog (or ourselves!). I'm just happy when his backbone isn't as prominant as it has been. He had gaunt hollows on either side of his backbone, and to me, that's a little too thin.
In the pictures, you can see in the first one how he stands now -- on the tops of his toes. The second picture sort of shows how much atrophy he's got in that leg, but believe me, the picture doesn't do the real thing justice. His leg is literally 2 (or less) inches thick when you look at it from the back or front. There is also no muscle tone in his thigh. I can push my hands together on either side of the "wide part" of his leg (if you look at it from the side) and feel his thighbone. With his leg so thin you can really see the medial buttress on the inside of his knee. AMVS suggested that I poke it with my finger to see how it feels. If it's pretty firm, all is well, but if it begins to feel softer like I could push my finger into it, then the infection is back. Oh joy!
You can also see how he has to curve his back so that he's got most of his weight centered over the left back leg. I'm sure his back aches. I've been massaging it.
The stitches and staple are OUT! The weather is nice so I think we can spend some more time sitting in the yard so that Winston gets a break from his room. He's been in there so long that we've actually started calling it Winston's room. He's getting around better, and even doing a little bit of toe touching to help balance himself, so we took the exercise pen down and we've got baby gates across both stairways. Josie and Tyler (our 5 pound 16 year old cat) find the gates a little inconvenient but they are learning to live with them.
May 6, 2009
May 6, 2009, 1 week check following wound closing
Winston's wound has been healing nicely and we're scheduled next week to take the stitches and staples out, but AMVS wanted to see him a week after they closed the wound.Even though the wound itself is healing, and the infection seems to be gone (he's still on antibiotics until May 19th), he isn't using his leg. The swelling is gone and now his leg is shrinking right before our eyes.
Don and I are still team lifting Winston in and out of the car, so he comes home for lunch and we get Winston loaded and unloaded. Both Dr. Trousdale and Dr. Duerr are really happy with the way the wound is healing -- apparently it's doing better than they expected. Hooray!
After all his visits to AMVS, "skeptical Don" is finally a true believer that they genuinely care about their patients. The lobby has often been crowded when we've gone, and all the doggie parents commiserate with each other. Often we've seen each other before and we're able to ask or see for ourselves how so-and-so is doing now. As the staff comes out to take patients back to exam rooms or into the back, they all stop and say "hi" and give a little hug and a pet to the other pups that they know. It's a nice friendly atmosphere.
During our exam, Dr. Duerr brings up what they'd like to do next. They can't do another Tightrope because there is too great a risk of re-infection, so they would like to do a TPLO. There is still a pretty high risk of infection because he's already had one, but at least if he gets one this time, they don't have to remove any of the implants and his leg will remain stable. He also mentions that they know of our financial concerns (unfortunately I think we didn't hide the fact that we were seriously worried about money with each of his recent visits) and that the owner of the practice is willing to do the surgery at a large discount.
I'm still not excited about the TPLO surgery itself, to quote someone else out on the internet, "it seems wrong to break a bone to fix a ligament," but after all that we've been through, it actually doesn't sound that different from some of what we've already done. Also, last fall Winston had 4 "mostly working" legs and now he has 3. I'm willing to go ahead with the plan, but we have to go step by step before we know whether we can try the TPLO.
May 2, 2009
May 2, 2009, the bandage comes off
The bandage is starting to bunch up behind Winston's knee. I'm hoping that we can at least keep it on until evening so that it will be on three full days. It's pouring out today so I use another bag over his leg, but I'm running out of newspaper bags and I can't find the "old roll" of them left over from my paper girl days (wow... I've kept those around a long time!). I'm trying to use sandwich bags rubberbanded onto his foot, but as he drags his foot, they come right off. I use an old towel to dry off the bandage as well as I can each time we come back into the house.
Winston is getting used to the umbrella, and ignores it now. Late morning we go out again and he attempts to squat to poop. Finally! But he can't get his bandaged leg pulled forward enough to manage it, so he's half squatting on his left leg with this pegleg all bent behind him. I grabbed his leg and maneuvered it forward so that he could try to squat again. What came out of him sure didn't look natural. It was a tarry consistency and pretty bright orange in color. Hmmmmm.... At least it's a step in the right direction so I decided to not worry about it until we see how strange looking the next one is.
When we got back into the house, I tried to dry off his bandage, but after having gone out a couple of times this morning, the bottom part around his foot was pretty wet. I didn't think it would dry out all that quickly and in the meantime his foot would stay wet and cold. I guess it's time to take the bandage off even though we didn't make it to 3 full days.
I'm sure glad that I'd watched Dr. Trousdale put it on, because it helped me remove it in pretty much reverse order without having to worry about getting scissors out. I found the end of the vet wrap and unwrapped that layer by layer until I got down to the non-stretchy cotton bandage layer. It looks like an ace bandage, but it's very thin and has no give to it. I unwrapped that layer by layer until I got down to the cotton padding layer. I could see that his wound had drained a little bit, but probably only for the first 30-60 minutes that the bandage was on. There wasn't much fluid that had soaked into the padding at all, and it was all rock hard and dry.
Once the bandage was off, I figured I'd better be really careful handling his leg. Even I can tell that there's no stability there. It feels like I could just take the lower leg and bend it in any direction that I wanted. I don't see any way that this is going to heal up on its own. That really killed the small hope that I had up to this point that he'd be able to use it normally. The wound itself looks really good. It's held together with small blue stitches and it looks like a plastic surgeon had done it. It was a very fine line and all of the tissue seemed pink and healthy and as far as I can tell, it was adhering to the layers of tissue below the incision. I'm pretty pleased with the way it looks.
Winston has to wear the big sattelite dish e-collar at all times when I'm not sitting with him until we go get the stitches and staples out.
Winston isn't walking on the leg at at all, not even to toe touch. The swelling has gone down a lot, but not entirely. He seems more comfortable being on three legs now and the left leg is holding up under the extra weight now that it's not being too overburdened with a huge infected "thing" hanging off of it like it was a week ago.
His appetite is increasing a little, so I've increased the amount of food I'm offering him, but it's been so long since he's eaten normally, I'm still going to keep going slow with it. If I try to jump back into a normal amount of food for him, he'll end up with diahrrhea, and we don't need one more thing.
Dr. Trousdale called that evening to check on Winston. I told him that I had to remove the bandage that day and why I decided to. He said that it was the right thing to do.
Winston is getting used to the umbrella, and ignores it now. Late morning we go out again and he attempts to squat to poop. Finally! But he can't get his bandaged leg pulled forward enough to manage it, so he's half squatting on his left leg with this pegleg all bent behind him. I grabbed his leg and maneuvered it forward so that he could try to squat again. What came out of him sure didn't look natural. It was a tarry consistency and pretty bright orange in color. Hmmmmm.... At least it's a step in the right direction so I decided to not worry about it until we see how strange looking the next one is.
When we got back into the house, I tried to dry off his bandage, but after having gone out a couple of times this morning, the bottom part around his foot was pretty wet. I didn't think it would dry out all that quickly and in the meantime his foot would stay wet and cold. I guess it's time to take the bandage off even though we didn't make it to 3 full days.
I'm sure glad that I'd watched Dr. Trousdale put it on, because it helped me remove it in pretty much reverse order without having to worry about getting scissors out. I found the end of the vet wrap and unwrapped that layer by layer until I got down to the non-stretchy cotton bandage layer. It looks like an ace bandage, but it's very thin and has no give to it. I unwrapped that layer by layer until I got down to the cotton padding layer. I could see that his wound had drained a little bit, but probably only for the first 30-60 minutes that the bandage was on. There wasn't much fluid that had soaked into the padding at all, and it was all rock hard and dry.
Once the bandage was off, I figured I'd better be really careful handling his leg. Even I can tell that there's no stability there. It feels like I could just take the lower leg and bend it in any direction that I wanted. I don't see any way that this is going to heal up on its own. That really killed the small hope that I had up to this point that he'd be able to use it normally. The wound itself looks really good. It's held together with small blue stitches and it looks like a plastic surgeon had done it. It was a very fine line and all of the tissue seemed pink and healthy and as far as I can tell, it was adhering to the layers of tissue below the incision. I'm pretty pleased with the way it looks.
Winston has to wear the big sattelite dish e-collar at all times when I'm not sitting with him until we go get the stitches and staples out.
Winston isn't walking on the leg at at all, not even to toe touch. The swelling has gone down a lot, but not entirely. He seems more comfortable being on three legs now and the left leg is holding up under the extra weight now that it's not being too overburdened with a huge infected "thing" hanging off of it like it was a week ago.
His appetite is increasing a little, so I've increased the amount of food I'm offering him, but it's been so long since he's eaten normally, I'm still going to keep going slow with it. If I try to jump back into a normal amount of food for him, he'll end up with diahrrhea, and we don't need one more thing.
Dr. Trousdale called that evening to check on Winston. I told him that I had to remove the bandage that day and why I decided to. He said that it was the right thing to do.
May 1, 2009
May 1, 2009, rain
It's been raining. This is good for us in Colorado; we've been in such a long drought that there are people who moved here even 5 years ago that think this is unusual. This is how it used to be every spring.
The rain makes it hard to keep Winston dry and even harder to keep the bandage from getting wet. I've been putting newspaper bags over his foot and keeping them on with a rubber band so that I can remove them once we get back inside. He's still having a hard time bending his knee enough to keep his foot from dragging. We have to cross cement from the front door to the gate in the yard, so by the time we get across the cement and the flagstones and into the yard and back, the bag over his foot is trashed. They're definitely one time use! I'm also using our big "golf" type umbrella in an attempt to keep him dry. He's only three and a half now, so he grew up in the drought and doesn't know umbrellas since I usually wear a raincoat if I need to stay dry on a walk. The umbrella scares him when he happens to notice it out of the corner of his eye. I try to keep it farther up and back away from his head.
Now when I feel the bottoms of his two middle toes after getting back in the house, they do feel cold to me. They were just outside on the cold wet ground, so each time this happens I decide I'd better wait and check them again a little later. I wait 30 minutes and by that time, I don't feel a difference between my fingers and his toes.
He's eating a little more today. I'm not expecting miracles with his appetite change, so we're taking it slow. He ate a 5.5 oz can of dog food mixed with a quarter cup of kibble for breakfast. I increased that to a half cup of kibble at lunch and he struggled to finish it so I did the same for dinner. I also offered another can before bed.
He's peeing regularly, but no poop. Not really surprising. No input, no output...
The rain makes it hard to keep Winston dry and even harder to keep the bandage from getting wet. I've been putting newspaper bags over his foot and keeping them on with a rubber band so that I can remove them once we get back inside. He's still having a hard time bending his knee enough to keep his foot from dragging. We have to cross cement from the front door to the gate in the yard, so by the time we get across the cement and the flagstones and into the yard and back, the bag over his foot is trashed. They're definitely one time use! I'm also using our big "golf" type umbrella in an attempt to keep him dry. He's only three and a half now, so he grew up in the drought and doesn't know umbrellas since I usually wear a raincoat if I need to stay dry on a walk. The umbrella scares him when he happens to notice it out of the corner of his eye. I try to keep it farther up and back away from his head.
Now when I feel the bottoms of his two middle toes after getting back in the house, they do feel cold to me. They were just outside on the cold wet ground, so each time this happens I decide I'd better wait and check them again a little later. I wait 30 minutes and by that time, I don't feel a difference between my fingers and his toes.
He's eating a little more today. I'm not expecting miracles with his appetite change, so we're taking it slow. He ate a 5.5 oz can of dog food mixed with a quarter cup of kibble for breakfast. I increased that to a half cup of kibble at lunch and he struggled to finish it so I did the same for dinner. I also offered another can before bed.
He's peeing regularly, but no poop. Not really surprising. No input, no output...
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