White Shepherd Stories

Journey's Recovery Moving Along

 

Journey at VCA NW Veterinary Specialists

"Mom thought I had an emergency, but I was just bored".

 

Tuesday, August 23rd, 2016.  

Six days after surgery.  It seems longer.   Some improvements have been pretty consistent in the last several days.  Journey is gradually getting his appetite back, a little bit at a time.  He is drinking a little more water every day. His appetite is better in the morning, whereas it was normally best at the evening meal.  He does not have much interest in his kibble which was about 50 to 60% of his meals.  I have changed his meals to contain more things that he is super fond of and even different things he has not had for a while.  It is working and he is getting more interested in eating.  Breakfast this morning almost tempted me.  I fried chicken hearts in some coconut oil.  Then I diced up a giant apple off of our top tree - so good and sweet.  I placed the apple in the same pan with the coconut oil and sautéed them until tender.  I placed a small amount of kibble in Journey's pan and poured the diced apples & chicken hearts over the kibble.  I added some cottage cheese and some chicken broth and stirred it .  He thought it was one of the best things I have made in a long time.  So did the other dogs.  They had the same thing, but with their normal amount of kibble.  

On Tuesday, the 23rd, I realized I really needed to go into town for a few things.  I probably could have lasted a few more days, but I heard there was another heat wave due on Wednesday, so it seemed I should get down there as soon as possible.  I also had a prescription I needed to drop off at the pharmacy.  I did not feel comfortable leaving Journey home, so he went with me.  We are getting good at loading him. It was only in the low 70's and with the gate across the hatch opening, I am able to leave the hatch door up.  As long as I park in the shade, it is not too hot at that temperature.  I dropped off the prescription at the drive through.  

Pirate and Andiamo had to stay home again and they are sure getting tired of it.  Normally they all go, or if I don't have room for that I alternate who gets to go. Our next stop was Winco for groceries I needed.  I found a completely shaded spot in the far back corner of the parking lot.  I opened all the windows, left the hatch lid up and filled up the water bowls.  It was a long walk to the store front, but worth it knowing Journey would be comfortable.  I made the shopping trip as fast as I could and got back to the car.  Next we went back to the pharmacy for the prescription.  

We have had some interesting experiences getting prescriptions at Walmart.  Although they advertise that they carry prescriptions for pets now, it seems someone forgot to explain that to the clerks at the pharmacy counter.  Out first amusing experience was with one of Pirate's prescriptions.

Clerk: "What is the patient's name?"

Me: "Pirate"

Clerk: "Date of birth?"

Me: "June 8, 2007, I believe that year is correct?"

Clerk: "You don't know?"

Me: "Not positive, but I think that is it.  I have three and I remember the month and day, but sometimes forget the year.".  

Clerk: "Can you spell the name?"

Me:  "P-i-r-a-t-e"  

Clerk: "We don't have that birthdate".  

Me: "What year do you have?"

Clerk: "I am not allowed to give out that information".  

Me: "Well just change it to 2007 because I just figured it out for sure and that is it."

(She was not happy with that answer, but I think she did it.)

Then I asked her if she could be sure and put the pills in an easy open top bottle.  

Clerk: "I would need the patient's signature for that."

Me: "I will sign for him.  He doesn't sign things.  Same reason he needs the easy open bottles. He doesn't have thumbs. If he opened the bottle with his own method, he might eat all the pills at once."

I thought that was funny and felt sure she would think so too if she thought about it a little. Either she didn't think about it or she just did not think it was funny.  Her gaze at me never changed, she just gave me the same cold stare that she first gave me when I said I was not sure of his birth year.  I was beginning to think she was horrified at what a horrible mother I am.  

She went back to the baggies hanging on the rack and found ours.  But instead of giving it to me she took it to the little 3 sided booth area and told me to step over there and wait for the pharmacist.  I did that and began to think of how really funny I thought it was and amused myself with ideas of how to respond to any more questions.  

The pharmacist had apparently been listening to some of the conversation because she, unlike the clerk, was completely amused.  She even kind of kept it going by saying, "has the patient taken this medication before?"  

Me: "Yes"

Pharmacist: "Then you are probably aware of the dosage and instructions"  

Me: "Yes we are".  (The 'we' got a smile.)  I can bring him in if you want to ask him.  

Pharmacist: "That won't be necessary".  We were both aware of the clerk listening to our conversation.  

What fun!  I noticed that the package said K-9 on it, but I guess the clerk did not see it or know what it meant. Who knows.  It was funny anyway.  

I believe that this clerk was the same one who had helped me with Pirate's prescription.  This time I was prepared with the year of birth.  She asked me the name:  "Journey" and she also verified that he was a dog! She looked through the little drive thru screen and spotted Journey in the back of my car.  She asked, "Is that Journey".  I was tempted to tell her it was Pirate just to make it more interesting, but I just said yes it was Journey.  The clerk was a little friendlier this time.  And I was delighted to see two pharmacists leaning from behind the little half wall, looking at Journey, and smiling a lot.  I suspect that someone or two of them had given her some teasing about being aware of "K-9" on a prescription.  

Next we went home and I walked Journey before putting him in his gazebo.  He was tired and so was I.  

 

We all took a nap.  I fixed dinner after cooking a huge batch of 'Shepherd Pie'.  By the time it cooked, cooled off and was all cut and placed in individual servings in sandwich baggies to be frozen, it was about 4:30 in the morning.  I decided I did not want to take Journey outside for a walk in the large part of the yard.  I could not manage the stairs from the deck, with him in the sling, so I decided to take him into the small dog yard via going through the pool house.  

When I stood at the gate leading from the entry area to the pool, I saw an amazing thing.  It was nearing sunrise and I saw some "birds" that I thought were outside the pool house windows. They flew like swallows only maybe even faster.  They were black and seemed a little larger than swallows. I did not open the gate to the pool.  We all just stood there a minute or so until my eyes grew used to the darkness.  I then realized the 'birds' were actually in the pool house.  I also realized, about the same time, that they were not birds.  They were bats.  We went back through the garage into the house and went out the front door to walk in the large part of the yard.  

I know bats are not supposed to run into you, but these bats seemed to be kind of reckless flyers and I did not trust them.  The pool house has an open beamed ceiling and it is funny that I have spent a lot of time in that pool house and I have actually looked in the rafters, wondering if there could be bats in there.  I have lived here since 2006 and have never seen a bat in the pool house.  I also realized to the best of my knowledge I had never gone in the pool house at 5:00 AM before.  (Nor will I be going in the pool house at 5:00 AM again!)

My daughter, after hearing my story, sent me an article "Living with Wildlife".  It is about 8 pages of information about, and pictures of bats.  They are hard for me to like, but I did realize that something had happened with the mosquitos we were experiencing in the spring.  I tried to concentrate on the following sentence: "Bats are highly beneficial to people, and the advantages of having them around far outweigh any problems you might have with them."  Okay, I am going to try!

The article also said that a bat may consume its body weight in insects each night during the summer. (Yes!) Less than one bat in 20,000 has rabies, and no Washington bats feed on blood.  I still would not prefer having bats in the pool house, but if I only see them once in 10 years, maybe I can live with that.  There are three other ways to get to the dog yard.  I will be using one of those ways if I ever need to go there at that time in the morning.  

We all went back to bed after the walk and slept in a little.  It was a wild 24 hours.  I don't need to shop for a while and Journey is doing so well.  He is eating well, taking care of all his outside functions, and getting better every day.  He is placing his foot much better.  We are spending more time outside now.  Under the apple trees is our favorite spot.  I even tied Journey to a tree while I picked up some apples.  The deer are no longer coming in our yard to eat them as much, as I guess they are disturbed by the odd hours we are keeping, and the unexpected trips outside.   

I need some more lighting put up on the edge of the RV garage and maybe on the southeast end of the house.  It is very dark outside some of the time when Journey needs to go out.  I think as his eating becomes more regular, so will his other functions and we can better plan our walks.  However it will also soon begin to get dark earlier.  Since we have been walking at odd times in the middle of the night, I am not letting Andi or Pirate go out with us.  Pirate thinks it is exciting and he sets of barking full time as he races Andi around the yard.  That sets off other dogs in the vicinity and I doubt if the neighbors enjoy that.   So that leaves just Journey and me out in the dark alone.  We have mountain lions here, and bear.  I have only seen one bear on our property and I have never seen a mountain lion here ..... but I had never seen a bat in the pool house either.   Since I don't want to sing, or rattle a can of rocks, I would like a little more lighting.   

Well, that is about it for now.  More in a day or so.   

 

 

Journey's Knee Problem

I don't remember exactly when I noticed a problem with Journey's hind leg.  It doesn't really matter, because as it turned out, the trouble started way before I saw it.  I took him to our regular veterinarian, at Timberland.  Of course I was dreading the possible diagnosis of it being a Cruciate Cranial Ligament tear, (CCL).  He was no longer limping when I took him in, but his knee was swollen and sore.  The veterinarian said to rest him and give him Meloxicam, (anti-inflammatory) Tramadol for pain, and Ligaplex I, a dietary supplement.  I did this for several weeks, but as I observed occasional limping, I knew I needed to take him to the specialist.  

Dr. Lozier had done a TPLO operation on Quest, when he was 7 years old.  Dr. Lozier was so highly referred, I never considered anyone else.  Quest never limped again, nor did his other leg ever have any problem, which is a common occurrence after surgery on one side.  As often happens, or so it seems to me, Journey woke up on the day of our appointment, with out any sign of injury to his knee. We kept our appointment and Journey's exam lasted a couple hours. He was x-rayed, and handled to explore every area of both knees.  He was diagnosed with an early partial tear of the right cranial cruciate ligament with bilateral stifle effusion and mild right sided stifle DJD.  

The good news was that the tear was caught early, at a  5-10% partial tear.  So we discussed every possible procedure for his problem.  Dr. Lozier has seemingly endless patience and I could not believe how many questions I was able to come up with, that he patiently explained to me.  Together, we made the mutual decision of what the procedure  would be in reference to the proposed surgery.  Dr. Lozier anticipated that in Journey's case, it was very likely that the other leg was in similar condition.  We could not know exactly what we were dealing with, without the knee being scoped.  I chose for him to plan to do both knees if, after scoping it seemed merited, and if the surgery on the right knee went well. Dr. Lozier told me he would call me as soon as he had all the information on it.  We scheduled the surgery for August 19, 2016.  Both of Journey's hind legs were shaved and prepared for scoping and surgery.

 

Part 1   Technical Description

Arthroscopic examination of the right stifle revealed moderate synovitis and synovial proliferation. There were mild osteophytes.  A 5-10% tear of the cranial cruciate ligament was noted at the insertion in the caudolateral part. The radiofrequency  and motorized shaver units were used to ablate portions of the fat pads to improve visualization of the cruciate ligament and menisci. The radiofrequency thermal shrinkage probe was used to remove some of the visible damaged portions of the cranial cruciate ligament. The remainder of the CCL was left intact. The medial meniscus was assumed to be normal but could not be visualized with the intact cruciate. The caudal medial miniscotibial ligament was not treated. Visualization of the medial aspect of the stifle caudal to the collateral ligament revealed a normal SMT and joint capsule. The medial meniscus was not treated. The caudal aspect of the lateral meniscus could not be visualized but was assumed to be normal. The lateral meniscus was not treated.  

The articular cartilage appeared to have suffered an area ofgrade III(advanced partial thickness wear) damage on the craniomedial aspect of the lateral femoral condyle where it appeared that external rotation of the tibia resulted in impingement against the lateral aspect of the lateral intercondylar eminence. The insertion of the caudal lateral component of the damaged CCL appeared to be trapped between these two structures as well.  Internal rotation of the stifle (tibia) appeared to relieve this area of impingement. Finally, radiographically the proximal tibia was in mild valgus and there was a mild external tibial torsion. For these reasons the tibial osteotomy was also internally torsed simultaneously with the TPLO The cranial aspect of the caudal cruciate ligament was moderately frayed. 

While attempting to rotate the proximal tibia following the osteotomy no motion could be achieved. This confirmed the complete synostosis at the tibiofibular joint that was suspected from preoperative radiographs. A lateral approach was made over the tip/fib joint and an osteotome was used to separate the synostosis. Rotation was easily accomplished after this. A right tibial plateau leveling osteotomy was performed. The surgical separation at the synostosis was kept to a minimum and no attempt to stabilize this was made. Mild internal tibial torsion alignment was performed simultaneously with the TPLO and attempts were made to reduce the valgus by several degrees.  The sites were lavaged.  Closure was accomplished with 2-0 Vicryl Plus.  

Arthroscopic examination of the left stifle revealed mild synovitis and synovial proliferation. There were no osteophytes. No tearing of the cranial cruciate ligament, was noted in the craniomedial band. A drainage canula was not made. The portion of the medial and lateral menisi that could be visualized appeared normal. Neither menisci were treated.  In the same area were the cartilage damage noted grade I fibrillation was occurring on the left side.  However, no cruciate fiber tearing had occurred. The cranial aspect of the caudal cruciate ligament was normal.  

Comments: It's my impression that external rotation of the stifle +/- genu valgum is an important factor causing the impingement noted and the cartilage and cruciate damage and even potentially the synostosis. I am not 100% confident that the outcome can be expected as good with a typical cranial cruciate ligament tear which I believe is due largely to hyperextension. Furthermore the breakdown of the synostosis will somewhat compromise the stability of the TPLO. Finally there was less damage in the left stifle then expected based on radiographs. All these reasons contributed to our electing to stop after one side as opposed to continuing on with our original plan of a bilateral procedure.  The owner had been for-warned with the possibility of stopping at side one and was satisfied with our decision making process.  

Note: I omitted some of the technical description of the materials used in surgery: plates, screws, blades used, templates, etc.   

The above is as technical as I am going to get on the description of Journey's surgery. I am also not going to post close up gory pictures of his leg, so you can breathe a sigh of relief.   It is pretty serious stuff as they must cut the bone and reposition it. That is probably about as much as anyone wants to know anyway. But the description above explains why his TPLO was not as easy as the one Quest had, and why there are more worries associated with his recovery.  

 

PART 2     The Long Recovery begins

Dr. Lozier called me a couple times during the operation, to report findings and double check on choices when he felt it important.  I trust him and his judgement more than I can say.  He is not only a wonderful surgeon, he is a wonderfully kind and considerate person. When the operation was finished he called me with a full description.  Journey was still under sedation, so he said his tech would call me as soon as Journey was conscious.  He said that there was a 95% chance that Journey could come home the next day (Saturday).  He did.

I knew it would be scary.  It was scary with Quest, but this one is worse.  Possibly in good part because I know more and also because there are more troublesome areas.  

I arrived 15 minutes early, at 12:15. First I went into an exam room and one of Dr. Lozier's team members came in and went over everything with me.  She answered questions, discussed medications, and directions.  When I felt fully informed she went to get Dr. Lozier.  He came in with models, and diagrams and explained everything to me.  I saw each bone that he was discussing and he showed me radiographs of the problem areas.  It was all very interesting, if a little overwhelming.  I was glad everything was also typed out so I could read it again.  He instructed me to call with anything at all that I might want to ask.  If something did not look right he asked that I photo it and email it to him.  (He requested that if I did, to also please phone and leave message so that he would for sure check his email right away.)  He said if the people I talked to when I called could not answer my questions to ask to be put through to his extension and leave a message directly to him.  He said to call with any problems whatsoever, any time of the night or day.  He said to ask for the tech in charge of taking care of Journey, and that I could call for a status report on him at any time I needed reassurance.  I have never had to leave one of my children at a hospital, but I seriously wonder if I would have received such care and attention if I had.

Then Heidi brought my boy in to me.  He was a little spacey on his medication, but he was actually moving pretty well in his sling.  Heidi walked out with me and we loaded Journey in the back of my Subaru wagon.  I cross-tied him on his comfortable quilt so that he could reach the water and was not at risk for falling if he stood up.  I got in the car and we were on our way home.  I talked to him while I drove.  Not sure he was following me, but he seemed okay with whatever I mentioned.  We had to stop for gas, and I got some colder water for us both.  When we got home I opened the gate and drove in.  When I got to the house I left Journey in the shade while I went in and put the other dogs outside in their yard.  I then unloaded Journey and walked him a little before taking him in to his gazebo.  He settled in and I opened the door for the other dogs to come inside.  They fussed over him and sniffed and kissed through the gazebo wire sides. They were so happy to see each other and Andiamo just kept whimpering and sniffing him.  Pirate was equally happy to see Journey, but he wanted to get in the gazebo with Journey.  It was kind of a confused evening.  We walked but he did not seem to need to go.  I fixed his dinner, but could not get him to eat anything except some cottage cheese.  He seemed to enjoy that.

I slept on the couch where I could see and talk to Journey if he needed reassurance.  The other dogs also slept beside the gazebo.  Journey may have been hurting and a little out of it with his drugs, but i know he felt loved.  He went to sleep.  I cannot tell you how many times I had to wake up and study his tummy to be certain it was rising and falling rhythmically.

Everyone woke up early and I put the other dogs in their yard so I could sling-walk Journey out by the apple trees.  He was not placing his foot very well and he was not interested in anything except maybe going in the pool, which of course he was unable to do.  He was very distracted by the barking of the other dogs. We went back inside and started on pills, after which I worked out a way of keeping track of them.  i had some roast which I sliced thin and in small pieces.  I hand fed him alternately with the other dogs and he really seemed to enjoy that.  

Sunday afternoon Journey was sleeping comfortably and I decided I could go shower and wash my hair.  I hurried.  When I came out he was awake and had been licking his incisions.   Ekkk!  I checked everything.  It looked to me like there was a gap in the stitches, (maybe a half to 3/4's of an inch).  It looked deeper pink and it looked open.  I got on the phone to the ER immediately and explained.  They said to bring him right in.  I loaded him, using the sling to lift his rear. Not easy, but amazing how you can do things when you have no choice and no one to help.  Off we went to Clackamas, Oregon. About 59 miles.  I went in and they put us in an exam room.  By this time the sedative I had given to Journey had kicked in and he was pretty mellow.  

 

Following is an email I wrote to a friend, describing our ER run: 

We are home and I think he is doing pretty well.  I have a few concerns.  I don't think he is drinking enough water.  I know he is not eating enough, but the water worries me the most right now.  I believe he is eating enough for right now anyway.  I just need to really tempt him and he only wants small amounts at a time.  He enjoyed some small bite sized slices of roast beef.  I am going to get another chuck roast.  I got him to drink some beef broth from the roast too.  He seems to have a taste for rice and also cottage cheese.   No dog food has appealed to him except the homemade Shepherd pie.  He enjoyed it last night, but didn't want it this morning.  He just seems off his food a bit.  

 

His leg looks awful.  It is dark with bruises and swollen.  His ankle is very puffy and swollen as fluids have pooled there.  We had quite an adventure last night. Journey was sleeping and I decided to take a shower and wash my hair, about 6:00 PM.  I figured he would be safe for that long.  When I came back in the living room, his hurt leg incision looked like it was pulled open a little over a half inch.  It was wet from him licking it and appeared to be open deep.  I immediately called the ER and they said to bring him right in.  A nice doctor came in to see him and he really liked her.  He was actually kissing her and she really liked him.  His sedative was kicking in after the hour of driving him there. She examined him and determined that the area I was concerned with was just an area where the skin was turned under and the stitches were underneath so we could not see them.  Dr. Lozier does his stitches that way, then they dissolve instead of having to be taken out.  Because some of the swelling had gone down, the fold was more pronounced.  Plus, he made it wet and shiny by licking it, so it was a deeper pink.  I felt silly, but they said "better safe than sorry".  I worry about infection so much and it is so sore, I had not poked around.  It really did look open.  

 

They were so nice and didn't even charge for the emergency room exam and visit.  They said Dr. Lozier would be proud to know I was so conscientious with Journey's care.  So we were only out a few hours of time and a little over a hundred mile round trip to Clackamas hospital.  I am not sorry I went though, as I found out the incision looks like it is healing well.  It was hard for me to see that with all the bruising and swelling.  It has gone down a little bit though.  His ankle is very puffy and swollen.  Still black in color and it looks anything but healthy.  Also I was worried that he was knuckling under when he walked.  Doctor said it was not unusual and would most likely stop in a couple more days.  

 

He is still not eating very well, but probably enough for now.  I am concerned about him not drinking enough water.  I get him to drink some, but not as much as he should, especially when it is hot.  I am walking him and he does not understand strolling vs. race-walking. He wants to go in the pool, which of course, he cannot do.  We sat outside this morning and he seemed to enjoy it. He is peeing okay.  He has not eaten enough to do anything else yet.  He just wants small amounts of things he really likes.  In addition to eating some thin sliced roast beef.  He has eaten cottage cheese and he ate some Shepherd Pie (homemade) and some yoghurt.  He also drank some beef broth, which was encouraging.  I am able to let the other dogs go out in the yard with us.  They are being very good.  Once we are sitting under the apple tree, I just have to watch them closely so they don't bump Journey. They are worried about Journey.  They would not even go swimming without him.  That was a surprise.  

 

I need to pick up some different things at the store to tempt him.  I will also stew a chicken for him.  If I can't get him to drink water, at least he will be getting more liquid with the broth. I don't feel comfortable enough to leave him home alone. He could do such horrible damage if he should try to get out of the pen.  Plus he absolutely throws a fit when I put the elizabethan collar on him.  He rams into stuff and just goes kind of crazy, so I can't leave it on him when I am not there.  And of course I can not leave him without it on him. He has not done anything drastic "yet", but as it gets better, it might get itchy so who knows.  I thought I would go shortly, as soon as the sun goes down, to pick up a bunch of things to tempt him.  It is not that hot today and I can cross tie him in the back, with the hatch open.  I will just park in the shade.  I will stock up so it will probably see us through the next heat wave.  I had not counted on him not eating dog food.  I have plenty of that.  

 

I let him get out of the gazebo and let him lie down under my desk while I have been working on the computer.  He is so happy.  That is one of his favorite places and I am not letting Pi or Andi share it with him and that makes him even happier.  

 

If you have any ideas on how to get him to drink water, please let me know.  

 

We have an appointment with Dr. Lozier on Sept 3rd, barring any more scares before then.  He should be pretty safe by then as far as the stitches go.  That will really be a relief.   

 

_________________________

 

When I was talking with Dr. Lozier we were discussing the details of walking Journey.  I needed guidance on how far and how fast, etc.  I asked if he was only supposed to take care of business and go right back in his pen.  Dr. Lozier said he could sniff around a little, and he said we could sit out on the lawn for a while.  As he was describing the preferred walk, how long and how fast, he sort of demonstrated "the walk, sniff a little, then walk". It was cute, and he then found the right word to describe the speed.  He said we should "mosey" around a little.  I got it.  So as we were walking and Journey was trying to drag me, I explained "mosey" to him.  He really did not get it.  I am still trying, but mostly yelling at him to stop pulling works a little bit.  Wish I had trained "mosey" during all of our classes, or "slow motion" or something.... 

 

Well I still need to give you a report of yesterday, our busiest day.   But right now it is walk time, dinner time and pill time.  I will save it for the next installment.  

 

 "Journey, please, please, please drink some water".

 

Pirate and Andiamo entertaining Journey (in gazebo).