July 10, 2020

Surgery day!

Today is surgery day! Aspen is going in early and will be sedated to get x-rays of his hips and knees. Once the vet reads them, he will call me with the game plan. Hopefully he will be able to fix Aspen’s hurt knee, but I am also interested in maybe getting both his knees modified at the same time. So we will see what the vet thinks is best! 

I’ve been preparing for a post-surgery house where Aspen can’t run, jump, or play - so I will share what that looks like once I’m sitting at home playing nurse to my big baby boy! 

Everyone please send pawsitive vibes our way today! And enjoy this picture of my happy boy! 

July 9, 2020

CCL surgeries

I think I discovered the entire alphabet learning about CCL (canine crutiate ligament) surgery repairs. There's the TTA, MMP, TPLO, and CBLO for STARTERS. And apparently each orthopedic surgeon has his favorite. So what the heck will they be doing with each surgery?

Suturing techniques - EXTRACAPSULAR STABILIZATION/LATERAL SUTURE (ECLS)- the least invasive of the surgeries, the surgeon inserts a suture that will act like the CCL ligament. It will eventually loosen, but scar and fibrous tissue will build around it and start to act like a natural new CCL. With TIGHTROPE (TR), the surgeon uses a flexible tape to go around the joint to stabilize it. These surgeries have been around the longest, but are recommended for dogs under 40lbs with low activity levels. These types of surgeries are also the least expensive costing less than $2K in Indianapolis.

Tibial Plateau Leveling Ostomy (TPLO) - this one seems to be by far the most common repair for larger dogs. It has been practiced since the 90's, so it's also tried and true. With most of these surgeries, the surgeon is actually changing the dynamics of the knee. The surgeon cuts the top of the tibia (tibial plateu) and rotates it a pre-determined amount so that the load applied to the knee is at a lesser angle. The surgeon will also implant a surgical plate between the cut bone and the tibia to stabilize the bones while they heal. This surgery is the most invasive with the largest incision.
Healing time: 10-12 weeks, Cost: $4k-6k (Indianapolis)

CORA-based Leveling Ostomy (CBLO) - CORA means center of axis rotation. This procedure is a newer form of the TPLO, but involves less of the articular cartilage and does not involve the growth plate of the leg (for young dogs not done growing). The cut into the bone is less, so the healing time is less as well.
Healing time: 6-7 weeks, Cost: unknown

Tibial Tuberosity Advancement (TTA) - this procedure uses the patellar tendon to stabilize the knee by sectioning into the tibia and moving the tibial tuberosity anteriorly so that the tendon inserts at 90 degrees. The surgeon will place a titaniam cage in the bone cut so that bone can grow around it as well as insert a metal plate to stabilize the joint. These surgeries are good for dogs with a certain degree of tibial slope and have been around since 2005
Healing time: 10-12 weeks, Cost: $3.5k-4.5k (Indianapolis)

Modified Maquet Procedure (MMP) - this procedure has been around since 2014 (but over 50 years for human knees) and it is similar to the TTA procedure because the surgeon will cut into the tibia to move it to be 90 degrees to the patellar tendon, but instead of a cage or plate, the surgeon inserts a titanium wedge to fill in the void within the bone. Bone tissue can then grow through the wedge and make the tibia stronger. This procedure uses smaller hardware and a smaller incision site which leads to faster healing times.
Healing time: 6 weeks, Cost: $3k-4k (Indianapolis)

I am a medical professional, but definitely not a veterinarian or orthopedic surgeon. The type of surgery your dog may need will vary based on age, weight, activity level, and the tibial plateu angle of the dog. So most of that stuff is out of your control anyway. What I've read has stated that it is mostly surgeon preference and that the TPLO vs TTA-type surgeries fair about the same. It appears that that the TPLO procedured is the one taught/practiced in veterinarian school so it seems to be more prevalent than some of the newer surgeries.

I personally have decided for Aspen to undergo a MMP procedure. I trust the surgeon (friend of a friend basically) and think Aspen will do best with a shorter recovery period. For some crazy reason, I am actually thinking about getting BOTH KNEES done at the same time. As previously mentioned in my first post, 50-70% of dogs will tear their opposite CCL. Aspen is already showing some effusion in his other knee due to putting 109lbs on his good knee for almost 2 weeks. Of course, the ultimate decision will be made once the orthopedic surgeon gets complete x-rays and examines Aspen himself. I won't know until I get that call Friday if Aspen is getting both knees, one knee, or no knees done (if he suggests Aspen would be better off with a TPLO surgery over the MMp... ya know, tibial plateau stuff). So of course, the anxiety monster is running rampant over at my house.

Aspen does have a WISH LIST of goodies to help him get through his surgery. Other than that, please wish us luck!

July 8, 2020

When your dog tears his ACL

A tragic situation has brought me back to my blogging. I've missed writing and have so many stories left to tell. But first, I want others to know how to navigate the current situation I'm in - my dog Aspen has torn his ACL (actually known as his CCL - canine crutiate ligament).

Aspen is practically albino, so he has always had sensitive skin. When a "sore" showed up on his left leg, I thought it would heal with a little bit of time. Unfortunately, he started to limp as well. So we made a trip to the vet and got the bad news - something was wrong with Aspen's knee.

While at the vet's office, Aspen would not let the vet move his affected knee around to complete a "drawer test". Doing a drawer test, the vet stabilizes the femur and tries to move the tibia forward like opening a drawer. Even without the test, the vet was pretty certain there was a partial or full tear of Aspen's CCL.

I immediately started researching what the crap a CCL was, how do you fix it, and how do you know your dog has hurt it. Once I read through some of the signs, I knew immediately that's what has happened to Aspen.

1. Toe touching: When a dog has an affected knee, the dog will stand on all fours, but slightly raise the affected leg off the ground so there is no weight on the knee. Aspen had already been doing this when I noticed his limping. You can see his back left paw isn't firmly planted on the ground like his other paws.

2. Sit sign: When a dog with a CCL injury sits, the affected hind leg will extend out when sitting because it hurts to bed the knee. You can see in this picture that Aspen puts his left leg out straight because it hurts to bend his knee.

3. Swelling: Aspen has been so stoic, I didn't really notice he was in any pain. How does your dog let you know that they are hurting? But when I felt the front of both knees at the same time, I could tell his left knee was DOUBLE the size of the other one. I have been giving him carprofen - an anti inflammatory - and also trying to apply cold therapy to help with the swelling. He wasn't super excited about the cold being on his leg, but once I wrapped it more, he would tolerate it. I found the best time to do it is at bedtime when I'm still awake reading and he's passed out beside me.

A few days later, I scheduled an appointment to have Aspen put under sedation to get a better exam of his knee and X-rays. Well, the blog is called Bad Luck Jenn for a reason. I received a call from the vet letting me know that she was able to manipulate Aspen's knee under sedation, but that after an X-ray of his OTHER knee, the X-ray machine broke. They were not able to get x-rays of Aspen's sore knee to see what exactly was going on. But with the extreme swelling and a positive "drawer sign", I was told to take Aspen to get surgery asap.

Now I'm deciding all these things - what type of surgery to get, where to get the surgery done, how to move my money around so I have THOUSANDS of dollars for his surgery. And then I know that no matter which surgery he ends up getting, rehabiliation and life post-surgery is going to be extremely difficult in my house. Aspen is 2.5 years old and basically still a big, goofy, uncoordinated puppy. And his younger sister, Opal, is even more energetic & always wants to rough house.

I'm meeting with an orthopedic surgeon FRIDAY to discuss options for Aspen and schedule his surgery as soon as possible. There is a 50% chance that once a dog has torn a CCL, the dog will tear the other one. Currently Aspen is adjusting all of his weight - 109 pounds - to his right knee, so a quick surgery is needed before he has too much work on the right knee and tears it's CCL as well.

Stay tuned, I plan to blog about the whole experience from start to finish. My next job is to decide which surgery to have - TTA, MMP TPLO, or CBLO. Yeah, that's a bunch of letters that I had no idea what they meant either.

Aspen has created his own WISH LIST for things to help his recovery.

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