Goodbye my friend

Since my last post Winston continued to have good days and bad days.  Unfortunately the bad days started to outnumber the good days.  We tried to keep his pain under control but he started to have days where he just couldn't cope with it.  He would stand all hunched up with his head down and pant.  He couldn't get comfortable lying down, he couldn't sit, he struggled to walk, but he was in so much pain that when he did walk he'd kind of shuffle along.  The first time this happened, we were able to get the pain under control again, but it got to the point where the relief he got only lasted for an hour or two.

After an especially bad night, I walked out with him to go potty and he told me that he was ready to go.  I sat out in the yard with him for awhile and cried.  We took him to AMVS that morning and we stayed with him to the end.

Doing better than expected

So on Friday we let Winston try the stairs and so far so good.  He's a little limpy when he first gets up but once he walks for a little while he limps less.  Today we did a 5 minute walk and he was so happy to be off our property!    He limped a little more on the way home than he did on the way out, but still... not too bad.

One week since front leg sprain

Winston is walking better and must feel better because today he actually wanted to chew on a chew bone that is down in his pen.  Tonight/tomorrow I might try letting him go upstairs and we'll use a baby gate.  He's still got swelling around the joint, but most of the welling in the leg around the joint has gone down, so it's looking much better.  I think we've got a week to go before I try taking him for a walk down the street though.

It's hard to have only one good leg!

Winston is on three legs again.  Last month he and Josie ran out the door like crazy people (like always) and we didn't realize the back patio was a sheet of ice.  He slipped and landed on his front leg with his foot bent over (normal bend, but put a little too much flex in the joint).  We've been pretty careful with him since then keeping his activity level down and not going for walks with him when he seemed sore.  Everything seemed good and he appeared to be nearly normal again so we've been a little less careful than we apparently should have been.

He played with Josie in the yard a couple of days ago (usually this involves her running around like a wild girl through the whole yard while he spins in small circles egging her on and lunging at her as she goes by).  Apparently he must have re-aggravated the sprain because he's got a little bit of swelling and some warmth in his wrist, and he's been hopping around mostly on three legs when he does get up.

Our vet said we should tack him to the floor for awhile, so he's back in his pen in "his room" with short potty breaks as his only exercise.  So far he's ok with this, so that makes it seem a bit more serious, but at the same time, he refuses to eat meals in bed (he gets up and stands to eat), so it's also not as bad as we've been through in the past.

Running around nearly every day

For the past week or so, we've had pretty decent weather.  Lots of sunshine and a few days in the 60's so I've been opening up the gate between the yards or just letting the pups go out into the southwest side so that they can enjoy the grass and sun.  They've both been playing with the balls out there and Winston has gotten in some running.  Probably helps a little with the muscle atrophy.  So far so good on the pain, I haven't had to increase his dose yet, though I have given him his dose early a few times, and sometimes we shorten the walks if they've been really active in the yard.

Still doing ok -- no more incidents so far

I think I'm being more careful in my monitoring of him and erring on the side of just increasing the frequency of pain pills if I see any behavior that is a little "off".  So far so good; it looks like the plan is working.  Winston hasn't had any more really bad days.  In fact we've had some recent decent sunny days in the high 40s and 50s.  I've let both dogs out into the big yard and they've been running around and having fun.

He's definitely got a "weather leg"

My poor boy.  Winter is definitely harder on him than summer.  Changes in the barometric pressure definitely seem to affect him.  Mostly we can manage this through pain meds.  It's too bad that he doesn't do well on Rimadyl, so we're stuck with Tramadol.  I don't know if Tramadol ER is available for animals, but I might have to check into it.

We have had a couple of "incidents" since the weather got colder where he was in a lot of pain, but it came to a head a couple of weeks ago.  He was outside with Josie enjoying the nice weather for most of the day. We were in and out using the tile saw (we're re-tiling a bathroom) and every time we went outside, they were just lounging about enjoying the sunshine.  Once the sun started to drop, it got really chilly so I brought them inside with me and I sat down to read a few chapters of the book I'm reading when Winston got up and moved in front of me with a weird little noise.  I looked out the window and saw the poor 3-legged fox out there eating something.  If I'd paid closer attention, I would have realized that Winston was trying to tell me he hurt and I could have thrown more pain meds at him then.

A couple of hours passed before Winston tried to stand up again and it was a struggle.  Once he got onto all fours, he was leaning as far forward as he could be to take weight off of his back legs.  I gave him Tramadol then.  He moved downstairs and laid down in "his room" and stayed there.  I fed him a little food at dinnertime, but he wasn't all that interested.  At bedtime he decided he needed to go out and tried to stand up.  He kept trying but wasn't able to.  I finally tried to help him stand up and he screamed in pain.

He made it outside, but he was leaning forward and shuffling along and grunting and moaning in pain with every step.  It broke my heart.  I gave him more Tramadol and then set the alarm for every 4 hours to give him more Tramadol all night and laid down on the couch at the top of the stairs so that I would know if he needed anything.  At midnight he woke me up shuffling and making small pain noises.  I really didn't know if "now" was the time that it would be kindest to put him down.  Sure seemed like an easy decision at the time.  Unfortunately with him not able to stand up, there was no way I could load him into my car by myself.  When I woke up my husband to see if he would help me, he refused.  He wanted to wait until morning and see if it was better then.

I gave him more Tramadol and every 3-4 hours I gave him more.  By morning, he seemed slightly more comfortable and could stand up after a struggle.  I kept up with the every 4 hours schedule for the next 3 days.  By that time, he could stand up without too much struggle and it seemed as though most of the pain was in his left leg (the one where the hardware was removed from).  We slowly extended the time between pills and after a week, we are back to every 8 hours which is "normal".

I wish I knew what caused this and I'd take steps to prevent it, but it's still a mystery.  After 5 days I started walking him again for 5 minutes, and after 4 more days, we're walking around the little block again which is a 15 minute walk.  Today I might do the next block (20 minutes) and see how that goes.  They're bored just walking around the little block.

We've put his ball away where he can't get it, but yesterday when I went out to pick up poop, he and Josie ran around the yard chasing each other.  It was only about 5 minutes of running, but he seemed ok afterwards.

Standing on that left back leg?

Since my last blog entry I've been paying more attention to the little details about how Winston uses/doesn't use his back legs.  For a long time after his last surgery, he wouldn't fully stand on his left hind leg.  Most of his weight was on the right leg and he had the left foot down, but I could tell it was more for balance than anything else.

Lately I've been noticing that he really looks like he's standing on that leg.  I can see that the toes are more splayed on the right foot than on the left foot, so I suspect that there's still more weight on the right leg than the left, but he's doing better.  He also doesn't shuffle around as much to push off with the right leg when he stands up.  Again, it's still the right leg doing most of the work, but there's definitely some left leg use.

Amazing how little improvements like this make my day!

5 months post TPLO explant

I can't believe that it's been 5 months already!

I'm happy to report that Winston is doing pretty well.  We can walk 3 decent length walks (we're limited by his size and ability to cool himself down at this time of year before we're limited by his back legs).  He also gets some free times in the entire yard, but we can't do that daily or he reaches a tipping point where he gets too sore and then we have to cut back on all exercise.  We limit this to every other day or every third day.  He won't restrict himself, so we have to evaluate how sore he seems before we open the gate between the yards.

He's still on pain meds, and that's how it will be for the rest of his life.  We've been able to cut back the dosage a bit as long as we manage his exercise.

He's still got some muscle atrophy in his back legs, but not too bad.  I also notice that he doesn't fully use the left hind leg.  For example, when he stands up, he shuffles his back legs around under him until he gets the right one in place, and he uses that one as his "push off" leg.

He runs and plays soccer with his big green horse ball, and is generally a happy guy, so we can live with the restrictions that we've got.

10.5 weeks post TPLO explant

It's been a bit of a roller coaster since Winston got his hardware removed.  He has had kind of a rough time and I questioned the decision more than once.  At the same time, I really don't think the main problem is the hardware or the removal.  He's just a big guy and he's got arthritis and it's just going to get worse over time.

He's on pain pills for the rest of his life, and some days seem to be better (or worse) than others.  Yesterday was one of those days, and today there's some lingering soreness.

At the same time, he's a pretty happy dog and he gets to play and he can go for "normal" walks and life is getting back to normal for us.  I just think the definition of "normal" is slightly different now than it was before.

Day 5 post left TPLO "explant"

Not much change between yesterday and today other than today Winston stood up to eat instead of being served in bed.  He also seemed a little more concerned about me doing his leg exercises.  He's been standing up more, so maybe his leg is a bit more sore?  He doesn't really stand on it yet (still), so I'm unsure.  Still no word on the results of the lab culture, and as far as I'm concerned no news is good news.

Winston's incision looks good.  The swelling is going down and his skin doesn't feel as warm as it did on day one.

Today it's rainy and gloomy and Winston wanted to wander around the yard during his potty breaks, but we don't want his incision getting wet, so that didn't happen.  He's bored in his pen, but doing ok.

Day 4 post left TPLO "explant"

Winston continues to get better.  He is moving more easily today and when I did his leg exercises, he just relaxed onto his side and seemed unconcerned.  I was able to do a full bicycle motion today.

When standing, he is still toe-touching, but when he walks, he is putting even more weight on the leg than he has in a month.  The back pad of his foot looks fully engaged, and his back looks straight as he walks.

Today is the first day I don't feel so guilty about putting him through yet another surgery.  I'm hopeful that he can get to a more "normal"state.

Today is also the first day that I might have heard a result of the lab culture (though maybe that depends on when the sample got to the lab... so realistically maybe tomorrow would be the first day).  No news at this point is good news.  I'm hoping for the best.

Winston's incision looks good, and some of the swelling has started to go down.

Day 3 post left TPLO "explant"

Winston is doing much better today.  He's walking more normally on his right leg and is actually putting some good weight down when he walks on the left leg.  He isn't struggling so much to stand up.  He's interested in both food and water.

I'm feeding him while he is lying down.  Our next major step in "progress" will be when he starts standing up to eat.

Today he let me do his full set of range of motion exercises without being too concerned.  The leg feels tight and he's worried about what I'm doing, but the action in his knee feels smooth not "clunky" like it did before.

Saturday, Day 2 post left TPLO "explant"

Last night was kind of rough.  Winston was uncomfortable and restless.  He's in his "room" in a pen down on the landing and I slept on the couch at the top of the stairs.  Every time he moved and rattled his big e-collar I woke up.  I think I kept one ear open for him all night.  He gets pain pills at midnight so I just stayed up til then and then tried to sleep afterwards.  He wanted to go out at midnight but then even though he shifted around a lot, he stayed put until the cat alarm went off at 5:30am.  He was really stiff, but was able to stand up under his own power.

As the day went on, he wanted to go out and go potty nearly every two hours.  There were a few times that I just told him to settle back down.  I sat in his pen with him and read a book to keep him company.  He was happy for that.  I tried to move his leg and was able to move it for about 5 repetitions, but it's still pretty swollen and he finally leaned over to put his head across my arm.  I figured this was an improvement, so I let it go and we did the same thing again later in the day.

He's eating ok, but wasn't really interested in water until evening.

Winston's back home after TPLO plate removal

We picked Winston up at noon today and I was a little surprised to see that the recovery for this surgery is very similar to the previous surgeries.  Two weeks of almost no activity and then we can start walking again starting with 5 minute walks.  The difference here is that every few days we can increase by 5 minutes instead of every week or two weeks.  Actually, I guess this makes sense because he hasn't had regular exercise in over a month and his muscles have noticeably atrophied in that time.  If we do too much too soon, he'll be too sore to move.

We're to start PT asap, and that will be critical as he heals.  I'm to start doing the passive exercises with his leg 20 repetitions three times a day every day is what our paperwork says.

I was a bit horrified to see him walk as they brought him out to the car.  He looks awful and it looks like his right leg doesn't work right anymore either.  It might have been kinder to just put him down instead of putting him through this again.

We got him home and I sat with him for a bit.  He finally struggled to stand up and couldn't manage it so I helped lift him up with the sling and helped him outside to go potty.  This is not a good sign.  He came back in and went to sleep for the rest of the afternoon.

At dinner time I helped him up again and we went out for a potty break.  He is definitely not walking normally.  It looks he went horseback riding for several hours and his legs are bent into that "cowboy" shape.  I'm pretty worried.

I fed him dinner in bed, and he was interested in food, but not water.  I tried to do his passive exercises and he leaned over and took my arm gently in his mouth to tell me to stop.  I remember how I felt the day after my shoulder surgery and if someone had tried to move my arm for me that day I would have gladly shot them, so I decided we would try again tomorrow.

Later in the evening, Don took him out to go potty and said that he'd stood up on his own.  Winston's incision had drained all over his leg and made a puddle on his bed.  It looked ok, so I blotted up the puddle and left the residue on his leg alone.

Left leg TPLO plate removal today

We dropped Winston off this morning for removal of his TPLO plate and a check of the meniscus in his left knee.  Putting him through this again was heart wrenching.  He figured out what was up as we loaded him into the car, and he was not a happy camper.  When we got to AMVS and we went into one of the exam rooms, he started crying and buried his head in Don's lap and begged us in doggy body language NOT to leave him here.  My poor boy.  I wish I could explain that we were trying to make him better.

I chose the DNR option again, and there was a part of me that honestly expected to get a call that Winston had died during surgery.  I wouldn't be surprised if he just gives up.  The hours crept by, and the more time passed without that call, I figured that he'd made it through surgery.

Finally, Dr. Duerr called to say that the surgery had gone well.  He said that a couple of the screws were loose, and he hardly ever sees that, so he's going to send off a culture to the lab to see if there's an underlying infection going on.  Also the meniscus was torn and frayed, so they removed part of it.  He wasn't sure if they were going to keep him overnight or if he could come home later, so he said he'd call back in a couple of hours and make the decision at that time.  After another hour, they called back and decided to keep him overnight.

Checked by the vet

Winston has been in pain off and on since my last blog.  I tried taking him off the pain pills but every time I do and then walk him farther than around the block (about a 15 minute walk), he ends up on three legs again.  It's a little depressing.

Today we went to AMVS to get his leg checked.  Without doing surgery it's hard to say exactly what is going on, but they suspect that he's torn his meniscus.  We're to continue with pain pills and continue resting him while we consider our options.  The best option for Winston is to remove the TPLO plate, and check/repair the meniscus.  It sounds like the recovery from surgery isn't as bad as having the TPLO done in the first place.

We're expecting a tax refund this year.  I guess it's going to Winston.

Another setback?

For the past month, Winston's been getting some limited free time in the back yard.  First we walk and then he gets some time to be loose in the yard while I pick up poop and small branches that the tree has dropped.  We don't have any toys back there for him to play with so he thinks it's a little boring, but I don't want him running a lot yet.

The foxes have taken up residence in the neighbor's old pool shed next door, so there are times that Winston has run along the fence, and he seems to do ok with that.  Josie is so excited to see him run that she's been trying to get him to join her running around the yard.  Sometimes he does, but not always.  

Yesterday I let them into the side/front yard (we live on a corner) and that's where Winston's big (horse sized) jolly ball has been sitting for over a year waiting for him.  He was so excited to see it and get to play with it that of course he did.  He didn't run hard, just an easy trot, and then he lay down and squeezed it a bunch.  After awhile I called them back to the back yard and shut the gate between the yards.

All seemed well until last night before bed.  When I called the dogs to go potty before bedtime Winston was on 3 legs.  He wasn't using his left hind leg.  Hmmmmm..... I guess he overused it today?  I gave him some pain pills and we all went to bed.

This morning he was extremely limpy but at least was using his leg again.  I've continued the pain pills and he doesn't get to walk or play today.

4 month update

Winston is doing well, and our walks are getting longer.  We get to walk through the neighborhood to the east of ours in addition to ours to make our longest loop and the walk takes about 50-60 minutes depending on how fast or slow we are.  Both dogs are loving the extra time and sights.

I've been loading them into the car and taking them with me when I run errands so that Winston learns that not all car rides end at the vet.  Sometimes we'll park and walk in a different area, but it's been so long since we've been out in "public" that the dogs need a refresher course on manners around other people.  I'm working on it.

March 9, 2010: Week 14 and all is well

Winston is allowed anywhere in the house except for beds.  He thinks this stinks.  We figured if his leg bone was only 80% healed at 12 weeks, it's best to wait until at least 16 weeks before we risk him hopping off of one of the beds.  He's still got a lot of muscle atrophy in his left back leg, and a little bit in his right hind leg, but with any luck and a little time and some more PT exercises that will get better. 

I've started Winston (and Josie because whatever he does, she wants to do too -- especially when there's biscuits involved) back on some of his physical therapy exercises at home.  Also when we encounter people (with or without dogs) on our walks, I'm asking both my dogs to sit while the other folks go by.  I need some more practice with timing on that one.  If I give them the biscuits too soon, they'll both stand up and bark or lunge.  This is new behavior since Winston had all of his surgeries and Josie joined our family.  I think it starts with her, but I could be wrong.  I can tell that Winston isn't as trusting of people as he was before all of this.  Anyway, distracting and bribing them with biscuits seems to be working, so hopefully with time they'll just focus on me instead of whatever's going on around them.

After our afternoon walk, Winston gets some off-leash time in the back yard.  I take him out on the leash and wait until Josie has run around looking for any stray bunnies that might be in the yard, and then I let him off the leash.  So far so good with this.  He has done a few trots and a little gentle run from time to time but so far not a lot of activity and no full-out "get the bunny" running.  I won't let him in the front yard until he's built up his leg muscles a bit more.