Post-TPLO—Day 74: Finally, a Trim

When I got my first Irish Water Spaniel, Cooper, and saw how much professional groomers charge to bathe and trim an IWS, I decided to learn how to do it myself.

I decided that, except for specialized help I’d need grooming for a conformation show, I would do it all myself: combing and brushing, bathing, drying, scissoring and clipping, plus of course, nails and ears.

That may have been a miscalculation.

Because what that has meant is that my dogs are not used to being groomed by a stranger. So when I need help with it all, help is not easily available.

I bathed and clipped Carlin the day before his surgery, almost 11 weeks ago. He wasn’t able to jump up into the bathtub or onto the grooming table. So the clipping happened on the living room floor, and the bath in our walk-in shower. Which meant I did most of it while I was sitting on the floor.

And the weekly combing and brushing since then? All on the floor.

I gotta say, over the years, I’ve gotten used to standing up while combing, bathing, and clipping. It’s a LOT easier that way. This being on the floor is hard. Especially the older I get.

But today, it reached 80 degrees, so Carlin’s almost 11 weeks of filthy coat had to go.

But of course, he’s not yet allowed to jump up on anything, much less a grooming table or bathtub.

So, today we were on the floor again, this time outside on the front porch, in the shade. Carlin was mostly lying down. His standing for any length of time isn’t happening yet.

We skipped the bath. I’m too worried about his slipping and injuring something. so I just did clipping.

I managed to reach most of the nooks and crannies with the clipper, using a short #4 blade. I did some scissoring, but no matter how I handled them, their pointy ends seemed to be just a bit too close to something tender.

I did discover that Carlin really doesn’t like the clipper’s vibration over the titanium plates in his knees. So I had to use scissors there.

All this would have been easier if I’d had someone to help me.

Which, if I’d started getting grooming help when he was a puppy, would have been more doable now.

But now, with Carlin’s weakened state, the stress of post-surgery, plus my worries about re-injury? No. This isn’t the time to introduce someone new.

So, I just got it done myself. It’s not pretty, but it’s shorter and cooler. It’ll be easier to comb.

And for now, I’m putting off worrying about his nails. That’s a whole other, sad, frustrating tale I’ll tell when we get there

Post-TPLO—Day 68: Some Good Progress

Rehab has been a lifestyle around here. Rehab exercises twice per day, plus an about-40 minute leash walk. And the beginning and ending exercises were done with both dog and person down on the ground. Those were the PROM (passive range of motion) exercises where, while Carlin works on a peanut butter-filled Kong, the person flexes each of knees 10 times. Followed by 10 minutes of ice on each leg. All while sitting on the ground. Then, a bunch more exercises (not down on the ground) followed by another session of PROM. Which means getting back down on the ground, and then up again.

I mean, I’m sure it was good for me. Maintaining flexibility and all that. But it was getting old. For everyone.

But starting last Thursday: yay! No more PROM. No more icing. The swelling around the joints is all gone. And all the other exercises can be done with the person standing up. Mostly. So much easier.

And! That’s not all. Carlin gets to go up and down the three steps to the house now. No more ramp needed to get into and out of the house. And that means that (yay! again) Carlin can also use the dog door to go out into the small kennel to take himself out to potty. So much easier.

In my last post, I reported that the rehab vet had us stop the gabapentin for pain. But after just a couple of days, I noticed Carlin seemed to tire more quickly on his walks. He also went back to squatting to pee about half the time. So they had us go back to the 400 mg of gabapentin, but just once a day rather than twice. I consider that progress, too.

We’ve also changed up the exercises. The cavalettis poles are now set to about 4″, rather than the 1″ they’ were set to last week. And we’re making the back stretch exercise a bit tougher—his front feet are now up on 6″ platform (at the vet; at home we have a 4″ platform). To the back stretch, we’ve added the weight-shifting exercise. And the weight-shifting has changed, too, so that we’re actually lifting one back foot at a time off the ground, rather than just swaying his hips from side to side.

And lastly, we added a walking-backwards exercise. He remembers that from all our rally practice, and pretty much goes straight backwards. As long as it’s against a wall, and only about 5 feet. But that’s good!

That walking-backwards exercise makes me laugh. When I was first training it, I didn’t want to use the word “Back” because that has a specific (and completely different) meaning in field training. And one of my classmates at the time used the command “Beep-beep”, as if her dog was a large truck backing up. So I adopted that, too.

Never did I dream I’d be telling my dog to “beep beep” during rehab for TPLO.

Post-TPLO–Day 56: A New Rehab Routine

Well, today is the 8-week mark we’ve been waiting for. The day that, maybe, Carlin could return to something of a careful, but more normal life. But, it turns out, it’s going to go slower than I hoped. Still no stairs, no jumping on the bed, no running, no playing with Grits. Sigh.

Where we’re starting now is with two things:

• An elimination of the pain medicine
• Additions to his rehab routine

Carlin has been taking 400 mg Gabapentin, 2 times per day for about 6 weeks now. Before that, he was on that amount 3 times per day. But today the rehab vet suggested we stop the drug, and watch him closely to see if there are any signs of pain. Like what?, I asked.

Well like, hunching his back, or being less willing to walk or do his exercises, or vocalizing pain, or starting to limp again, or refusing to participate in anything, loss of appetite, looking depressed. The rehab vet wants us to watch him for the next couple of days until his next appointment on Thursday, and then report back. If it looks like he has discomfort, then we’ll go back on the Gabapentin.

At the same time, she’s adding a couple of exercises. One is slow walking over some cavaletti poles that are spaced about 2 feet apart and, at least for right now, only about 2 inches off the ground. I understand that these exercises are good for improving balance and strength. They also get the dog to pick up their legs and move their leg joints differently that they would move with just regular walking. This all makes the workout more comprehensive.

The other is doing very tight figure 8s around posts. The posts are positioned only about 4 feet apart. This is to get him to bend his spine while walking. They also help with the sense of balance as well as help strengthen the muscles that maintain balance. Like the cavalettis, this exercise also helps the dog feel where their body is in space.

Of course, both of these exercises are taught with string cheese lures. The rehab visits also still include the cold laser and the PEMF therapy, and for those, he’s persuaded to stay on the mat using a peanut-butter-filled lick mat.

At home were still doing the passive-range-of-motion knee flexing exercises, icing, back stretching, and moving his hips side to side. Now we’re adding the cavalettis (as soon as the equipement arrives) and the figure 8s.

Carlin loves the rehab vet. Who wouldn’t, when apparently endliess string cheese and peanut butter are involved. And this is a very good thing, seeing as how it’s going to go on for months yet.

Post-TPLO—Day 47: Peanut Butter to the Rescue

When your vet tells you about surgery for your dog, they talk about why your dog needs it, how it will fix the problem, a bit about how it’s done, which medications you’ll need to give, and, possibly, what rehabilitation your dog will need. All very factual.

What they don’t tell you about is whether and how the aftermath will change your life.

Carlin’s surgeon recommended no rehabilitation, no physical therapy. All they wanted us to do was do strict crate rest with potty breaks for three weeks, and then daily leash walks starting at 5 minutes per day and then increasing my one minute per day. That’s it. And that sounded kind of easy.

But no rehab just didn’t accord with my own experience with joint surgery. I got my full range of motion back because I had physical therapy. And I have a performance dog who badly wants to get back to work. So, despite what the surgeon said, we started therapy just over a week ago with a veterinarian who specializes in rehab.

All well and good. But going to physical therapy comes with homework. We have to do several exercises with Carlin twice a day. It’s been time-sucking challenge. In large part because Carlin has really, really disliked it.

I think the first exercise in the series is the worst. It’s called PROM, or passive range of motion. Basically, we want to make sure the knee returns to full flexibility. So we start by getting Carlin lying on his side, and then, keeping the knee joint touching his body, gently pull his hock (like a person’s heel) up toward the base of his tail as far as it will easily go. We hold the knee in the flexed position for 5 seconds, let go, and then do the next one, for 10 repetitions. On each knee.

The first several days, he made this whine/growl noise when we tried it. We got maybe two repetitions on each leg. The rehab vet said it was fine to stop when Carlin complained, and then just try it again next time. After several days, we did get up to 10 reps each leg without too much complaining on most (but not all) sessions. But there was still with a lot of squirming and attempts to get up or away… It was just hard. And it made me cry in frustration. Maybe this is why the surgeon didn’t recommend rehab.

Rehab is, as I know from my own experience, not easy and very often uncomfortable. So I understood where Carlin was coming from. Totally. So the question: How to make this all tolerable for Carlin, and thus for ourselves as well.

We tried to keep him occupied with peanut butter on a lick mat, but that was so so so messy. Peanut butter everywhere. All over Carlin, on my legs and shoes, on the mat, everywhere. Then Russ had a brainstorm—what about peanut butter in a kong?

That, finally, worked. We get Carlin one his side, on the orthopedic bed, and give him a peanut butter kong. We’re still very gentle, feeling for that angle that is just enough flexed but not too much. But today, we started getting 10 reps on each side, with no complaining and no trying to get away, all because of that blessed kong.

We let him keep the kong through the icing that follows, 10 minutes per knee. And then he does a “front limbs on a low box” stretch, and then another exercise where we shift the weight side to side from one rear leg to the other. We do these two exercises luring him with string cheese.

And then it’s back to the 10 more reps of the PROM on each leg, and another peanut butter kong.

(For those who are curious, I estimate that he gets about 2 Tbs of peanut butter in each session. I stuff it way down in and along the inside walls so that he really has to work to get at it.)

Post-TPLO—Day 37: Starting Rehab

I’m not sure what part of our first rehab appointment Carlin enjoyed most: the peanut butter-filled lick mat or the acupuncture.

The lick mat definitely kept him focused and busy while the vet techs were using the cold laser wand. And the string cheese kept his attention while they were showing me how to do some passive range of motion exercises on Carlin’s knees and a weight-shifting exercise for his hips.

But the acupuncture? I know some folks who think that acupuncture is all placebo—you think it’s going to make you better, so it does, or, at least, it feels like it does. But for a placebo to work, the patient has to know that he’s getting some treatment and have some faith in it. But a dog?

Carlin had no idea that a treatment was coming, and since this was his first experience with acupuncture, faith didn’t, couldn’t, really play a part. But as soon as the vet placed the first needle, Carlin’s body visibly relaxed. His face softened. His usual hyper-aware notice of the world around him shifted and almost kind of went inward. It was like it had taken a deep breath and let it out slowly. Like he had sunk feet deep down into the soft support of the dog bed. He allowed Dr. LeFave and the tech to pet him, gave them licks in return, and then put his head down and zoned out.

I’ve had acupuncture for myself. One time, the practitioner said he could help my very painful achilles tendon in 12 sessions. It took only 10. And it was a miracle. I’d fallen down some stairs and tore the tendon. I tried a whole raft of failed physical therapy, spent fruitless months in a boot, wasted time doing the whole rest/ice/elevation thing, and got frequent massages that felt good in the moment but didn’t help over the long term. Then several months later, after I’d cried my way through what was supposed to be a fun weekend trip, my massage therapist suggested acupuncture. And that worked, to my immense relief and gratitude. I’d about given up ever walking comfortably again.

Later I tried acupuncture for frozen shoulder. Same acupuncturist, but this time, he wasn’t sure he could help me, but he’d try. It didn’t work. At all. Didn’t relieve the pain or help me get back any range of motion. I had to have surgery.

I also got acupuncture for my first IWS, Cooper. We tried it to help his sore back, and that helped a bit. We tried it to see if it would help his SLO, but we didn’t see any improvement. So, with Carlin, I thought, maybe it’ll help, but maybe not. And I don’t know if acupuncture will help him over the long term. But, today, it sure helped him to be calm and happy. And for that, I am grateful.

Post TPLO—Day 30: A Minor Setback

Last night, on Carlin’s last trip out to potty, I noticed that he was limping and favoring his rear right leg.

My first response was worry. What if his pain wasn’t being controlled? What if the bone wasn’t healing? What if we were seeing the first signs of an infection in the bone? (Apparently this not an uncommon complication of TPLO.)

But of course, this all happened late at night. It seems like so many veterinary issues arise late at night.

We had options. We could take him to the emergency vet. We could just go to bed and see how he was in the morning.

Or we could give him some carprofen, go to bed, and get in touch with the surgeon in the morning. That’s what we did.

The next morning (today), Carlin was still limping. So we gave him another carprofen and reached out to the surgeon.

Basically she said that this is not uncommon. And it just means we need to slow down. Continue to keep him quiet. No running, no jumping, no stairs, no playing with Grits. Have him rest for a day or two (no walks except to potty), and then start over with the gradually increasing walks.

So tomorrow, if he’s not limping, we can go back to the beginning and take him for a 5 minute walk. And if all goes well, then the next day we can go it to 6; the day after that, 7; and so on.

This going backwards is disappointing. Staring with 5 minutes at day 21, and adding 1 minute per day, we had gotten Carlin up to a 12 minute walk. And we were looking forward to real walks that might soon get us off our street and into new territory.

And I know this is frustrating for Carlin. He wants to jump and run, and these puny walks just don’t satisfy.

Poor guy.

Post-TPLO: Day 27–Staying Quiet and Relaxed

Our instructions are to keep Carlin quiet as best we can for at least another month. Walking is limited to just a few (but gradually increasing) minutes per day. (Today we’re up to 10 minutes; tomorrow, 11; the next day, 12; and so on.) But no running or jumping, no going up and down stairs, no playing with Grits, not much of anything physical.

So we’ve been relying on x-pens all around the house to keep Carlin from doing all that stuff he’s not supposed to do; drugs (gabapentin and trazadone) to relieve his pain and anxiety; yak cheese chews to help him work out frustration; a couple of treat toys stuffed with frozen kibble and veggies to make him work for his dinner, and one or two very easy stationary scent work games to exercise the brain.

But what seems to work the best is just getting down and hanging out on the floor with Carlin and keeping him company.

Last night was Russ’ turn.

Tonight was my turn.

I spent about 20 minutes combing whatever coat I could reach. Carlin actually seemed to like it, at least until the comb got to his feet. That he didn’t find quite so relaxing. But he did like his belly hairs combed, and turned on his back to I could get to them.

The almost-month has gone by quickly, but at any given moment, seems like it’s been (and will be) forever.

Post-TPLO—Day 21: First (really short) Walk

Our instructions from Carlin’s surgeon say (and I quote exactly): “After 3 weeks, start a daily leash walk. Begin by walking once daily for only FIVE minutes. Increase leash walk time by ONE minute every day out to TWO months post procedure.”

Today is the first day after 3 weeks is up. So today we walked. On a leash. For only FIVE minutes.

That took us down the driveway and along the street about 2 houses-worth. That’s not much distance, but our regular vet added that we should take it very slowly. The slower the better, he said.

Carlin, of course, wanted to go much more quickly. But I held the leash handle up against my belly to give me some stability when he pulled a bit. And indeed, we went slowly. On a leash, for 5 minutes.

And, as an added bonus, he got to carry the mail back into the house with him. This has been one of his jobs, and he hasn’t gotten to do it for quite a while now.

Now he’s back in his X-pen, resting. No doubt looking forward to the day, two months post-procedure, when he’ll be up to 40 minutes per day, and perhaps going a bit faster.

Post-TPLO—Day 15: Cones Off and Walking

I’ve been impatiently waiting for this day for two weeks. The day when we send photos and videos off to Carlin’s surgeon, and hopefully get good news.

The two photos are of the incisions on Carlin’s knees. The surgeon wants to see: are they healed properly? Is there redness or discharge? Might there be an infection?

Right knee

Left knee

I texted those photos off, and got the good news I wanted. The incisions are healing just fine.

Fortunately, the stitches were internal and done with a dissolving material, so they don’t need to be removed.

We also texted her a short video of Carlin walking.

Carlin walking Day 15

I’m not really sure what she was looking for in this video. Maybe evidence of pain or instability?

But in any case, we got good news: “Amazing! Great work with Carlin’s recovery. Go ahead & take the cone off. We can discontinue the sling. Not much activity- just in & out to the bathroom for the next few weeks.”

I’m planning to use the sling now only when he’s on slippery surfaces, like getting him over the wood floors where we haven’t put down rubber mats.

And he’s still taking the trazadone and gabapentin, reduced to twice a day instead of three times. He seems to tolerate those well, and they’ll help keep him quiet.

As will some cuddle time.

Post-TPLO Day 8–Cones and Licking

Our instructions from the surgeon are clear: “…the Elizabethan collar must remain on at all times for the next 2 weeks to prevent licking or biting at the incision which would cause an infection at the surgery sight [sic].”

So of course, being a medical writer, I went on to read more about this.

OMG. That infection they warn against? It’s bad. If the area gets infected, the whole surgery can fail. The bone surrounding the screws can fail. And it can get even worse than that.

So, are we following instructions exactly as given?

No.

Instead, during the day, one of us has eyes on the dog at all times to make sure no licking occurs. That collar is so uncomfortable and unwieldy that we just can’t bear to force him to do that 24 hours a day. And fortunately, he’s willing to stop trying to lick when we correct him.

But at night, our eyes are closed and he must wear the collar, and for the first 6 nights that worked out well. But last night, not so much.

About midnight, Russ started hearing licking noises. It turns out that Carlin had bent the edge of the collar against the crate wall. This collar the vet gave us is not the hard clear plastic we’ve had in the past. Instead, this one is made out of this stiff coated fabric. But it wasn’t quite stiff enough, and when bent, it allowed him to get to his incisions.

What to do?

I remembered that we had a hard plastic cone from when Grits had her emergency spay. But of course, that had been stored in an out building, which meant traipsing out in the rain and the dark to go get it.

And then, once I brought it in the house, we realized that it was just barely big enough to fit around Carlin’s neck, and not long enough.

But we put it on anyway, and then put the vet’s cone on again, inside Grit’s cone. That way, the shorter hard cone would hold the softer long cone out straight and not allow it to bend, keeping Carlin from reaching the incisions.

And of course, we had to do all of this while he was standing outside of his crate. And for that to happen, one of us had to hold the sling under his hips to support his back legs. Under his hips meant that the sling was indeed supporting his legs, but also pressing on his bladder.

So outside in the rain and the dark Carlin and I went. Him wearing his cone collection and me wearing pajamas and boots.

Of course he couldn’t pee right away. He had to find just the right spot first. But once found, he did his thing and we came back inside. Him into his crate, and me into dry pajamas and back to bed.

I slept until 10 AM. This whole thing is exhausting.

Post-TPLO Day 7–Sleeping Arrangements

The day before we headed up to Sun Valley for Carlin’s TPLO, we set up a borrowed 52”x33” crate in our bedroom. We figured that even with a cone on, Carlin would be as comfortable as it’s possible to be when one has had the tops of both tibias sawed off and screwed back on.

We set the crate up in the corner of the room where we could see him and he could see us, and where it would be pretty much out of the way.

But Carlin wasn’t happy. Not only aren’t his legs working, but he’s used to sleeping in our bed with us. (Yes, I can hear the gasps of horror from some quarters. That’s OK; you do you. We’ll just go ahead and do us.)

So we made a little bed on the floor in front of his crate, and Russ and I took turns sleeping there. Occasionally Grits would join in, curled up by the sleeper’s knees.

But really, for a pair of senior citizens like us, that’s not sustainable.

Obviously, it was time for furniture moving. Not much. Just enough to get the crate up next to our bed.

This works better. We are definitely more comfortable, and Carlin seems more okay with it.

Wow, I can’t wait for the vet to look at Carlin’s incisions in a week or so, and hopefully tell us that we no longer need to worry about whether he licks them or not. He’ll still have to sleep in the crate, but at least he won’t have to wear that dang cone anymore.

Post-TPLO Day 5 — Pain Patch Removal

Since his TPLO surgery, Carlin has been taking a whole collection of medicines: anti-pain, anti-anxiety, and anti-inflammatories. He also has had a pain patch taped to his left rear foot.

Pain patch on Carlin’s left rear foot

Let me say right now that we don’t have any more of those patches. And Carlin’s original pain patch is gone, out of the house, taken to an FDA-approved take back location. The damn thing was a fentynal patch. And once it was off, I wanted it gone immediately.

The Sun Valley vet’s instructions was to remove the patch on Day 5. We got no instructions on how to take the patch off. And we didn’t ask. It looked pretty straightforward: just pull the tape off and the patch would come with it.

Once we started to try to get it off, we realized that this wouldn’t be quite so easy as we thought. We knew that the patch itself had an adhesive surface that held the medication up against the skin. Then the patch was taped over with two or three layers of a stiff, sticky medical tape. And on top of that was more tape with today’s date written on it. OK, I sort of get all that–no one wanted to risk the patch’s coming off somehow. That would have been dangerous for everyone: Carlin, Grits, and us.

What we didn’t anticipate was that only a small patch of coat had been shaved, just big enough so that that little patch of skin could accept the medicine. That means that all that very sticky tape was applied on top of the coat on Carlin’s foot. And it really stuck. It seems like every hair under that tape was stuck to the tape. There was no just pulling the tape off without also pulling Carlin’s coat out.

So, we had to cut it off instead. All the while, hoping that we wouldn’t accidentally cut or poke Carlin with the scissors.

First we tried blunt-tipped Fiskars. The tip of that pair, though, was’t sharp enough. Then we tried a pair of pointy grooming scissors. Those were a bit better, but by then, Carlin had curled himself into a ball to avoid us touching his feet.

Let me just pause and go off on a tangent here: It’s my experience that many IWS hate having their feet touched. All of mine have really disliked it, although Tooey wasn’t too recalcitrant and Cooper put up with it. But Carlin hates it. Oh, and I know about all those positive training methods. I’ve tried them all, and I’ve had several trainers try, too. Slowly over time, Carlin has learned to let me comb his feet and scissor them. Shortening his nails? I could write a pamphlet on that, but let me just say, it’s still a struggle. (Thankfully, the vet trimmed his nails while he was under anesthesia, so hopefully I won’t have to deal with that really soon.)

So anyway, finally we used my little thread clipping snips, cutting about an 1/16″ of tape and coat a time. It took both of us, taking turns. One of us on the floor, at awkward angles, trying to get at Carlin’s foot, while the other held his muzzle and collar so he couldn’t swing around and pull away. And of course, both of us were wearing latex gloves so we wouldn’t get any leftover drug on our hands.

After a bit, Carlin lay down and allowed himself to be bribed into letting Russ finish the job. I think the whole thing took about 30 minutes. We washed his foot with soap and water as instructed, and now Carlin is peacefully sleeping as if nothing happened.

Post-TPLO–Day 4: Pee and Poop Edition

The first night we had Carlin home was not easy for any of us. He whined much of the night, even filled with anti-pain, anti-anxiety, and anesthetic drugs. Friends have suggested the distress is a after-effect of the anesthetic.

But part of it may also have been the problem of peeing. To non-dog people, dog people often seem obsessed with their dog’s peeing and pooping. But you know, just like all of us, the dog’s got to go sometime, somewhere. And when you’re a dog with only two working legs, and those the front legs, the whole elimination thing becomes a real problem for dog and people alike.

We have a sling that goes under his belly. Somehow we’re supposed to use it support his back legs so that he’s not putting much weight on them, and at the same time, position it so it doesn’t cover up his penis. That proved totally unworkable for me. Either it was back far enough to support Carlin’s hips and legs, but cover the penis. Or it was forward under his chest, which frees the penis but isn’t as great as supporting the legs.

Carlin goes down the ramp on a sling

The first night, we resorted to putting the sling under Carlin’s chest and then expressing the urine manually. Basically, Russ held the sling and I pushed on his full bladder from both sides so that pee would come out. He had a lot of pee. It needed to come out. Which it did, all over Carlin’s front legs and Russ’s shoes.

There are YouTube videos on how to express a dog’s urine. The dogs on YouTube seem fine with it. Perhaps it was my technique or just Carlin’s being anxious/annoyed post-surgery, but he didn’t like it. Not one bit. Fortunately, we didn’t have to do that more than that once.

There had to be a better way, so the next morning, we called the vet to ask for help. She basically told us to take him outside with the sling, and then drop the sling and let him pee if he needed to. If he had to sit, that was OK. But that day he surprised us, and actually lifted a leg next to a tree. And today, in the daylight, he found a rock he liked, and peed there.

Carlin finds a rock he likes

Since then, it’s still been a struggle for me, although Russ has gotten better at it. Perhaps Russ, being a foot taller than me, has better leverage for holding the sling. He supports Carlin with the sling under Carlin’s chest, while they find a good place. (Why, oh why are even heavily drugged dogs so particular about finding the exact right spot?) Once the spot is found, Carlin pees. Personally, I worry that this technique of walking around with the sling under the chest (even thought they’re very short walks) puts too much pressure on Carlin’s knees. And because of all the pain meds he’s on, Carlin doesn’t feel a problem. I don’t know. I hate this not knowing.

The surgeon told us not to expect poop for 5 days. But last evening and this morning, we got poop. See? I told you dog people are obsessed with poop.

Carlin’s Bilateral TPLO

While we were waiting for word on how Carlin’s double TPLO went, the folks at the Sun Valley Animal Clinic sent us some x-rays to look at.

The first x-ray shows Carlin’s left knee joint, pre-surgery. To a non-professional like me, this is puzzling. It doesn’t appear to me anything is seriously wrong enough to warrant surgery. But I’m thinking that’s because x-rays don’t really show soft tissues, such as the CCL, the ligament that the vet tells me has ruptured. But I can see that the top of the tibia is slanted from upper left to lower right. And without the CCL to hold the femur (upper bone) in place, that femur is just going to slide forward on the top of the tibia. (The x-rays of the right knee look much the same.)

The second x-ray shows the left knee from the same angle as the first x-ray. You can see that the top of the tibia has been cut through in a curve. The cut section of bone is rotated so it’s tilted to the right and up. This provides a flatter surface for the femur to rest on, so it won’t (hopefully) go sliding back and forth. The new titanium plate will hold that chunk of bone in place until the two parts of the bone heal, fill in, and fuse together.

The third x-ray shows the knee joint from the front, I think. It shows the screws that are holding the titanium plate onto the bone.

This is so creepy. And it looks painful, which is why my poor boy will be drugged with pain meds, anti-inflammatory meds, and anti-anxiety meds. He’s going to feel bad and not understand what’s been done to him. The meds should control the pain and ease his anxiety so that the stress response doesn’t slow his healing.

But the x-rays also look amazing. I am so grateful when I think of what veterinary medicine can do, and what might have happened to Carlin if these treatments didn’t exist.

I am so grateful. And also scared.

I know the recovery will be long and arduous for all of us in our house. Keeping Carlin safe and happy. Making sure he doesn’t lick his stitches. Preparing his crate so the weeks (probably) of his staying in it can be at least somewhat comfortable. Making sure he doesn’t use his legs too much, too soon. Figuring out how to help him pee and poop when two of his 4 legs don’t work. Keeping up on the meds. Plus, doing whatever else the vet instructs us to do. As well as keeping our other dog, Grits, entertained and out of Carlin’s way and away from enticing him to play before his legs can handle it.

Soon we’ll meet with the surgeon again, and learn what she found and what she advises us to do next. If all has gone well, we’ll load our boy in his car crate, and drive the 3 hours down the mountains and back to our valley home.

And when we get there, we’ll get him out of the car somehow, and the next phase will start.

Tibial Plateau Leveling Osteotomy (TPLO)

I’ve always wanted to go to Sun Valley. By the photos I’ve see, it’s a beautiful mountain area, home to a famous ski resort, second or third homes of celebrities, and host to an airport filled with private jets, several good restaurants and gift shops, and hiking trails.

And now, after 7 years in Idaho, I’ve finally made it to Sun Valley. But I never imagined that I’d start crying once I got here.

Russ and I are here to take Carlin to the Sun Valley Animal Center in Ketchum, Idaho, so that he can get a diagnosis and maybe surgery on his left knee. Somehow or another, Carlin injured one of his cranial cruciate ligaments (CCL). It’s the band of tissue that helps stabilize a dog’s knee joint. When the ligament is torn or totally ruptured, the femur (upper bone of the leg) shifts forward instead of staying in place on top of the tibia (lower bone). The shifting is painful, and to mitigate the pain, the dog tries to not put weight on that leg. This puts more pressure on the other back leg, back muscles, and spine.

Some times, that added pressure tears, or even ruptures, the CCL on the other leg. If that happens, the dog can’t walk well at all.

We don’t know how Carlin injured his knee. Last Fall, I noticed that he was “off”. He wasn’t able to concentrate on his scent work as well as he had in the past, and we failed 3 out of the 4 Detective searches we entered. He limped from time to time, but never cried or whined. He jumped and played with Grits as usual, but sometimes he’d snap the air to tell her to back off. I also noticed that he really didn’t want to stand for long on the grooming table, and I often had to hold his back end up because he couldn’t seem to do it himself.

I took Carlin to our regular veterinarian last October. They did an exam, and prescribed carprofen and gabapentin. They thought that maybe it wasn’t more than arthritis. But then, on Saturday January 20th, Carlin stopped using his left rear leg altogether.

That’s bad. And that’s when I took him back to my vet. She did another exam and took x-rays, and said she thought Carlin had injured his left CCL and likely needed surgery. She advised a second opinion, and recommended a surgeon who could help us decide what to do. He, of course, did yet another exam, and concurred. The CCL was injured and needed help. We discussed multiple possible procedures. The problem? The surgeon didn’t have any openings to do anything until early March.

I just couldn’t make my dog wait that long.

So many dog people here in Boise suggested we consult the surgeons at the Sun Valley Animal Center. Apparently lots of folks, even from surrounding states, travel to Ketchum for orthopedic treatment for their dogs. Including performance and hunting dog people. So we called that clinic, and we got an appointment for today, January 31.

So here we are in a Ketchum coffee shop. We dropped Carlin off earlier this morning, where we talked with the surgeon, looked at new x-rays, and listened to the explanation of why they recommend the TPLO. With three opinions all saying the same thing, we agreed, left our boy in the clinic’s hands, and went to the coffee shop to decompress a bit.

And that’s where I started crying. Why? Because while we were there, the clinic called us to say that the CCL in the left knee was not just injured. It had completely ruptured, and the CCL in the right knee was torn and about ready to rupture, too. Carlin, they said, needed TPLO in both knees.

We agreed. Doing both at once will mean only one session of anesthesia, one (but longer) period of recovery and rehab, and a little less money. So now we wait to hear that it’s over, how it went, and how our boy is doing. And while we wait, I cry.