Wednesday, November 30, 2011

Your Warm & Your Cold: Compress Instructions

Buster rested most of the day but on his afternoon walk, he trotted on a little further.  He also tried to stand only on his hind legs this afternoon.  We are drugging him but we will be increasing the dose.  Certainly his left leg was worse than his right leg because he just didn't show so much energy and enthusiasm last time.  Also he was out on much heavier doses of tramadol and Acepromazine.

Today I'll talk about how we handled cold and warm compresses.  Many vets (and human doctors) recommend using a pack of frozen peas for an ice pack.  I put some ice in a freezer bag and reused the same pack.  I don't like to waste food and I won't eat peas that have partially thawed and frozen repeatedly.  I always wrap the bag of ice in a medium-sized towel.  When ice is applied directly to the skin, it can cause nerve and tissue damage.  Wrapping the ice helps to prevent that.  Leave the pack on for five to ten minutes.  Cold compresses are usually used for about three days but follow your vets instructions.

Warm compresses are trickier.  They must be moist.  You can't just warm up a towel in the clothes drier.  As previously mentioned, I use rally and sweat towels for this purpose because they are easier to wring out and they can wrap around the dog's limb length-wise (see photo).  Simply wet the towel with warm (not hot) water.  I try to wet the interior and keep the center the warmest.  Wring out the towel, gently lift the dog's leg, and wrap the towel loosely so that it covers the scar.  We add a second dry towel over Buster's lower limbs and hips (not shown) to help hold in the warm heat (California homes are not well insulated).  Let it rest for five to 10 minutes.  Warm compresses last at least two weeks, after stitches and staples are removed, and possibly longer.

It is important that you do not use boiling water and that you do not heat the damp or wet towel in a microwave.  Heated water or towels from the microwave will burn your dog.  Do not use anything except warm tap water.  Test the temperature on the inside of your wrist like you would a baby bottle.

Of course, I am only a pet owner.  If your vet gives your any instructions that contradict mine, you must follow your veterinarian's instructions.

Don't be surprised if the warm compress helps draw out fluids.  That's part of of the reason for a warm compresses.  It also helps relax the muscle, which promotes healing.  Some vets will recommend that you do passive range of motion after or during a warm compress.  This is a case-by-case basis so carefully do as your vet recommends.

Tuesday, November 29, 2011

Shake a Leg

Buster remains restless.  Right now he's giving an indignant look about his imprisonment.  He paces a little and shakes his back half, something I don't recall him doing after his last surgery.  He certainly was more heavily drugged after his first TPLO.  He certainly is quieter when he's more heavily drugged.

He continues to be needy.  He even barked at me when I went upstairs to fold laundry.  I try to make it up to him by staying close and spending time giving him attention and affection but I can't spend all day at his side.  So I try to leave for errands every day, whether I go to the gym or to Costco (where we buy his frozen blueberries).

He did drink this afternoon.  He continues to drink water with diluted amounts of broth, a bit of pumpkin, or other flavoring.  We make plain water available to him at all times but he does not drink it.  So we offer the flavored liquid after meals and once or twice a day, allowing him to drink as much as he wishes when he will drink.

When he steps outside for his 2- to 3-minute forays, he is quite fast and heads off to the plaza every time.  I'm amazed at how fast he can move, despite the surgery.  Dog loves his plaza life.  I had to carry him home again today when he would not come back.  So much for my heavy lifting training!

Today Buster would like to give a shout out to his cousin, Hannah Hound.  Hannah was a stray who got hit by a car, which broke her leg.  A vet pinned her leg and later removed the pin.  Hannah went to the PSPCA, where my sister recommended her to Karl when he wanted to adopt a dog.  Hannah, in turn, recommended Sharon to Karl and a few years later they wed.  Good girl, Hannah!

The life of a stray is dangerous, as Hannah and Buster know.  They also know that most abandoned dogs don't end up with animal-loving families like theirs.  Spay, neuter, adopt, and keep your animals for life.

My family has a lot of pets.  If I work them all in, you will hear about dogs, cats, horses, lizards, and ferrets.  Those are just the current members...many others have spent their lives with us.  We are the better for it.

Monday, November 28, 2011

Head Tremors or Head Bobbing in Bulldogs

Buster had another quiet day.  On his afternoon walk, he started to jump and run.  So he is definitely getting extra sedative now.  He has 6 more weeks of restricted activity!

His suture check is tomorrow (today's picture shows his incision and staples and yes, a bit of drainage).  Hopefully the stitches will be absorbed enough that we can remove the cone of shame.   It is okay to remove the surgical cone 5 to 7 days after the surgery but we played it safe and kept it on him until the surgeons say his sutures are safe.  We'll update you tomorrow.

We've mentioned previously that we give Buster a little plain yogurt every day.  About 6 months after Buster's first surgery, he got up one morning and walked to the kitchen, where we were eating breakfast.  We looked over at him and saw that his head was shaking and lashes blinking involuntarily.  It was like a seizure localized in his head.  We asked for help on Twitter and a friend of ours, @That1EBD, referred us to a blog post about head tremors in bulldogs.

It's a fascinating and largely unexplained phenomenon.  Although the tremors could be caused by epilepsy or even diabetes, one bulldog owner and breeder extensively researched case literature and worked with a vet to find that bulldogs commonly have tremors in pregnancy (okay, Buster is a boy so we can rule that out) and after surgery.  It is unclear why this happens but it seems that it may be low calcium levels.  Please follow the link above for an in-depth discussion of the topic.  It is possible that a seizure could be indicative of epilepsy or diabetes so talk with your vet if this happens with your bully.

Suffice it to say that Buster had head tremors one time.  We have consistently given him a little yogurt with each meal and periodically let him have a small amount of frozen yogurt or vanilla ice cream.  I stress--small amount of frozen yogurt or ice cream.  FWIW, Buster recommends Yogurtopia.  We haven't seen any head tremors yet but they typically don't occur until 6 months post-op and they may not occur at all.

A Big Drink

Last night Buster would not go to sleep.  We went to bed and a short while later, he started barking to us.  I got up and checked that he was okay and gave him a sedative.  I held him and petted him and returned to bed. A few minutes later, he barked.  I had to lie down and hold him until he fell asleep.

Monday is a busy day in our house.  Buster spent part of the day alone, resting.  I came home and took him out briefly.  He trotted further today and I had to carry him home because he refused to come back.  Let the record show that I can carry a 70 pound dog half the length of a football field.  So, Buster is a fitness motivation for me...I have to keep up with my dog!

Today was the first day that Buster drank a lot.  We keep a bowl of water in his confinement area but he does not touch it, presumably due to the big Comfycone.  Sometimes he refuses a drink when we offer it.  Tonight I mixed a little liquid from garbanzo beans with a little chicken broth and a bit of pumpkin and diluted it all with water.  We think Buster drank a quart!  We added diluted broth to his breakfast and he still gets about a tablespoon of yogurt.  We'll need to devote a post to why Buster gets yogurt every day.

Today was the first day that Buster eliminated twice.  I mention this only because people who are nursing dogs after a surgery need to know that surgery can slow digestion down for a while.  It's been 10 days since Buster's surgery and related effects are still present.

Buster alternates between touching down, weight bearing, and carrying.  When he does bear weight, it is very light.  Nevertheless, he continues to improve.

Today's picture shows Bup just before bedtime, on his cushion, under a big grey towel, and in his Comfycone.  His big head is all that shows.

Sunday, November 27, 2011

Quiet Sunday

Buster rested a lot today because we gave him a sedative.  He's really hating the restriction and having to stay home to rest.  So he stands up and talks and wags his tail.  He will not settle unless he has narcotics.

He also refuses plain water so we're continuing to mix a little pumpkin with a small amount of chicken broth (made by boiling a skinless breast without salt) into his water.  He drinks that better.  We add a little of the broth to his dry food and give him some yogurt each day and some fruit.

We roasted another pumpkin and started freezing it in cubes.  If you are local, decorated with small pumpkins for Halloween or Thanksgiving and you plan to throw them out, we will take them.  If they are in good shape, that is!  If you have a dog, put the pumpkins into the oven whole (without cutting them open or removing the stem), roast for about 45 minutes to an hour.  Let the pumpkin cool and slice it in half with a knife.  It should be easy to cut.  Scoop out the seeds and peel off the shell by hand.  You'll have an instant healthy treat for your dog.

Buster is bearing weight lightly.  We saw him doing it last night at dinner.  Today he has mainly rested but we've noticed a slight regression because he's carrying more and touching down less.  It is normal for a dog to show progress and then to plateau or even fall back a little.  We remain encouraged that he is doing so well.

Some of the neighborhood kids who adore Buster stopped by to ask if they could walk him.  I had to explain that he had surgery and cannot take any walks.  For the record, we'd never let inexperienced people walk Buster nor would we let neighborhood kids walk him unsupervised (we don't even let our own teens walk Buster).  American bulldogs are powerful, require strong, patient leaders, and knowledgeable handling when they get stubborn.

There is now a video of Buster singing.  The video is rather bad; Buster is hardly in frame because if he knows I am paying attention, he stops.  It is not his best song.  I just played it back, which made him worried and now he is whining at me.  I believe Buster prefers that we keep that video for our own private use only.  Sorry--the song of the bulldog remains a family tune.

Saturday, November 26, 2011

Apples and Compresses

Buster had a quiet afternoon at home by himself.  We continue to have drainage from his leg but that's normal and its far less than it was a week ago.  The incision and stitches are visibly healing.  He still tries to make a break for the plaza whenever he steps out.  He's getting tired of the restriction and bored too.  Mom and Dad aren't as much fun, unlike Tammy, Stephanie, Kristen, Nicole...

Right now he's trying to convince us that he should be allowed to go outside to help with the grilling.  Dad needs a sous chef!  Who is better able to judge when meat should be eaten than a dog?  So the video shows Buster alternating regular barking and request barking to go outside and cook.  We tried to record him singing again earlier but he still goes quiet as soon as I press record.  The song of the bulldog is a family matter.

Bell, another of his rottweiler mix cousins in Pennsylvania reminded us that dogs like apples so he just ate a Granny Smith after having a warm compress.  In appreciation, he sent his butternut squash-sweet potato mash recipe to her.  We think the apple is another way to keep Buster hydrated and we continue to give him water with a little broth for flavor.  Also we put a small amount of broth on his dry food.

Enjoy the barking video--the tip of Buster's excited, hoop tail is just visible in the frame, over his cone of shame.

Friday, November 25, 2011

Fetanyl and Tryptophan

Happy Thanksgiving!  The tryptophan in turkey can bring on a yawn!  We removed Buster's fetanyl patch on Wednesday night.  Buster seems more alert so it was still active.   I kept surgical gloves from CPR and CERT training in the house so Jay wore those to remove the patch.  It was very well adhered!

After the patch was removed, we had to be sure Buster didn't lick that spot for six hours.  So we put another Telfa pad and some paper tape back over the spot for a day.  (Disclosure: I'm accident prone so I keep gauze, Telfa, antibiotic ointment, and similar first aid items in our home).

Buster enjoyed Thanksgiving, despite the Comfycone of Shame and restricted activity and all that.  He had a little bit of Dad's turkey and some mashed sweet potato-butternut squash.  He also enjoyed some roasted pumpkin while Mom and Dad ate pumpkin custard.

He's continuing to make fast progress.  He touches down and even puts a tiny bit of weight on his foot when we go out for air.  He is sitting beautifully, like a dog should instead of on one hip!  Buster still tries to head to the plaza and only turns back with great reluctance and bribery.  It must also be noted that he often only leaves the porch with great reluctance and bribery, we think, because he knows we won't really let him walk.

Seepage is greatly decreased and so is swelling.  He's even drinking water that has only a little broth mixed into it.  His appetite is excellent.  The staples and the sutures all look fine.

Buster's blog is proving popular.  It's only a week old and he's had 100 page views.  Thank you to everyone who is reading this and following Bup's progress.  Buster would also like to give a shout out to his cousin, Mack, who was hit by a car a month ago and is healing too.  In Mack's honor, we're posting picture of Mack playing with Cici today.  Keep going, Macky--you're healing great too, Million Dollar Dog!

Wednesday, November 23, 2011

Staples and Stitches, Oh My!

It turns out that Buster did not stop seeping fluids from his incision.  We had a really hard time determining the exact nature of the fluid.  How red is red?  How red is dog's blood?  We did not have this issue after Buster's first TPLO so we were really amazed at how much fluid came washing out of his incision.  It was like a daily bath.

We first noticed it Saturday night and called the surgical center.  They told us it was normal and to call back if it was still happening on Monday.  On Sunday morning, it had the metallic odor of blood and we were concerned by the sheer volume so we called again.  Normal.  It was still happening Monday.  Finally on Tuesday we said we were unnerved and that they had told us to call if it was still occurring on Monday.  We talked to one of Buster's surgeon's made an appointment and took him in for a suture check.  As the doc said, "It's free and why not have the peace of mind?"

The fluid was normal drainage.  However, our secondary surgeon said that she could "milk" Buster's incision and so she added a couple staples to keep him sealed up.  We confirmed that we are keeping him confined to a small space (as seen on this blog--about 5 feet by 7 feet).  We also discussed keeping him drugged up to keep him quiet.  For the most part he is resting calmly.

Buster is continuing to make remarkable progress, based on our experience with his first TPLO.  He is touching down most of the time but is not weight bearing.  He has learned how to walk rather quickly in his attempts to head out to the plaza, where his friends are.  He barked to Oliver and Madeleine when they walked this evening.

He clearly is bored and lonely but we are doing all we can to play and talk with him calmly.  He sang a lot for attention and to be included in cooking dinner.  I tried to record it but every time I've tried to record Buster's songs, he quiets down.  Ah, guess only Jay and I will know the exquisite singing of Buster, American bulldog.

Tuesday, November 22, 2011

Three Cones in Three Days

In three days, Buster's worn three collars intended to stop him from licking: Ejay Bite Free, Procollar Inflatable, and the Comfycone.  Actually, if you count the cone of shame that he wore home, he's modeled four collars.  Today's picture is an aerial shot of Bup in the Comfycone.  We liked the Ejay collar best but soon learned Buster could lick his lower leg while wearing it.  We then bought a Procollar and learned he could lick his knee and upper leg.  So then we tried the Comfycone.  At least he can't lick anything, except his foot.

As soon as we put the Comfycone on him, he hung his head.  You know the posture of a dog shamed by a lampshade?  Yep.

The positive features of the Comfycone is that it is easy to wipe clean and is adjustable.  The edges fold back so that your pup can eat and drink.  It is softer so the dog can lie down more comfortably.  Beyond that, it has the same disadvantages as a cone of shame--isolation, inhibition of the dog's movements, blocking peripheral vision, etc...

It is bendable to make it easier for the dog to eat and drink.  We don't find that the fold makes it much easier for Buster to drink and only makes it a little easier for him to eat.  Also when it is folded back, Buster can place his front paws against the fold and try to pull it off.

The Procollar's advantages are that it is very comfortable, does not block the dog's peripheral vision or isolate the dog, and does not inhibit the dog's maneuverability as much.  Our friends at Pyrenees Pets have heard that they pop.  For us the failure to prevent Buster from licking any part of his leg led to its immediate removal and subsequent return to the big box retailer.

The Ejay Bite Free's advantages are that it gives clear peripheral vision, maneuverability, is comfortable (it is foam-lined), and is adjustable.   The negatives are the name, that you have to measure your dog and special order, and that it didn't restrict Buster enough.

Annoyingly, the surgical cone that the surgical center used was NOT reusable.  This really bothers me because plastic is not biodegradable and we would have simply placed that back on Buster but instead had to cut it off him in the first place and then had to go out and spend more money.

We are not in love with any of these products, especially given that they are far more expensive than a typical surgical cone.  In the end, your dog should be kept quiet after knee surgery and should not move a lot.  You should be with your dog when he or she is moving through a room, so you should be guiding your dog past obstacles.  You are the eyes, ears, and leader.  So these cone alternatives, like so many pet products, are more for the owners than they are for the dog.

Monday, November 21, 2011

We Have Touch Down!

Buster is doing very well today.  He had extra sedative because both parents had to work in the morning.

He has been toe touching but not weight bearing since last night.  Today he typically has the post-operative toes on the floor without weight.  This is especially exciting because it is normal for a dog to begin touching down within 24 to 48 hours after a TPLO.  Buster took much longer after his first surgery so it is really exciting to see him progressing so quickly.

The edema at his hock is nearly gone today, whether because he had a lot of broth to flush his system or maybe from massage.  Also exciting to see so much immediate response.

He did try to head out for a walk today when mom came home from work but she made him turn around and come back to the house.  Surely he was strolling to Tassajara Commons and his many lady friends at the hardware, vet, and pet store.  Oh, and to visit the gorgeous blonde hair dressers too.

The leakage from the incision stopped.  So we didn't have to take Buster back to the vet today.

We don't think his fancy bite-free collar was working for him so he's now sporting an inflatable.  Seriously it looks like a swim ring.  He'll be able to go boating after he recovers.  Maybe that's mom's excuse to get a paddle boat.  Will they let me take out a dog on a paddle boat at Del Valle?

Sunday, November 20, 2011

Day 2 Regular Breakfast but Leaking Stitch?

Buster ate his regular breakfast this morning--one cup of food, glucosamine, a teaspoon of yogurt and an eighth teaspoon of ground flax seed. He also had his Rimadyl. He didn't drink yet so later I'll boil some meat without salt or fat to create a broth. I'll offer the broth to him by itself and if he does not drink, I'll put it on his dinner.

We are concerned that Buster is leaking. He's certainly losing blood from one spot. We called the center last night but they told us that it is normal and to wait until Monday. We covered the floor with his blankets to protect the carpet. Jay cleaned Buster this morning with a warm towel and chlorine-free baby wipes but he is bloody again. If this is still happening tomorrow morning, I will call first thing to speak with the surgeon.

One nice difference between the two surgeries is that our new surgeon uses internal sutures by default. Internal sutures do not require removal and their scar is less noticeable. We paid extra for internal sutures for Buster's first TPLO. It just seems to me that when you're paying thousands of dollars that they surgery centers should throw in some extras like internal sutures and follow up visits.

Swelling and fluid around the ankle is normal after a TPLO. Basically gravity draws it down from the knee. We noticed a little last night so we've been sure to massage Buster's ankle a few times daily.

He is still whining a bit when we are not on the floor with him. However, we do not want to encourage that kind of dependency or expectation that whining brings mom or dad running so we're ignoring him.

Saturday, November 19, 2011

First Day Home from Surgery

Buster came home today after one overnight stay. He was so excited to see us--he even gave mom a kiss. He was very bright eyed. As soon as we got him in the house, he went back asleep. We'll get some pictures later.

He has a fetanyl patch for a few days and then he'll use AcePromazine and tramadol and the-ever present Rimadyl. Frankly, part of the reason why we opted for both surgeries is that we want to stop using Rimadyl on a daily basis. Rimadyl isn't the best thing for a dog's health and we're not big on pharmaceuticals for people or animals.

The photos with this post show the meds Buster needed after his first surgery: antibiotics, Ace, tramadol, and Rimadyl plus his usual glucosamine and Bendryl. This time the surgeon injected the antibiotics and because of the fetanyl, we don't need tramadol until we remove the patch on Wednesday. Currently he's taking a half Rimadyl twice daily (which is standard for him). Tramdol and Ace are only as needed.

So far Buster is doing very well but has some leakage from his stitches. He didn't drink much today but when I spoke with the surgical center they said he'd still be well hydrated from the IV liquids during his surgery and hospitalization. He ate his regular dinner, plus a couple bits of roasted pumpkin, and a blueberry. He's been outside once. He did have a brief whining period but the drugs have kicked in and mom and dad both snuggled him until he settled. He did sleep most of the day.

How Do You Know if Your Dog Needs Knee Surgery?

How do you know if your dog needs a TPLO or has a torn cranial cruciate ligament (CCL)? Primarily you must have a vet diagnosis it. Because we had such a difficult time getting a diagnosis (the 4th vet we consulted diagnosed it), I'll list some of the symptoms and signs here; I don't want other pet owners incurring so many bills and such worry.  Please be aware that I am only a pet owner, not anyone qualified to diagnosis a dog.

First, dogs only have knees on their back legs.  Knees bend forward; elbows bend back.  You have knees and elbows and so does your dog.  An elephant, however, has four knees.  Your dog only has a cruciate ligament on his knees.

The first big sign may be that your dog sometimes limps. You may think s/he is limping, look more closely but s/he is not. You may notice a light limp one day and not see it again for a week or a month. ACL tears or ruptures often show up this way initially.  Although you check the dog's foot for cuts, scapes, and foreign matter, there will be nothing.

You may also notice that your pet does not put full weight on the injured leg. If it seems that the dog's toes are just touching the floor, s/he s probably not bearing weight on that leg. If you can gently sweep the dog's foot, s/he is not weight bearing.

Your dog may sit differently, with one leg outstretched or to the side.  The picture of Buster in the pool shows improper position in both legs.  The picture of Buster in the cone of shame demonstrates proper leg position.  Initially Buster sat with his left leg to the side but after his TPLO on the left, he extended his right leg.  Your dog should sit with both legs under his butt.
As time goes on, the pain will worsen. Your dog may begin to carry the injured leg. When a dog carries, s/he holds the leg up by its side.

Your dog may spend a lot of time checking or licking the foot.  This can also mean that your dog is anxious, bored, or cleaning his foot.  This cannot be your sole determinant.

If you dog shows any of these signs, document them in writing or with photos and head to the vet.  The signs covered in this post are all things that you can observe.  Your vet will check different things and we'll discuss some of those in another post.

Friday, November 18, 2011

Here We Go Again

A bit of background: Buster is a rescued American Bulldog. We liberated him from a suburban SPCA nearly three years ago. Shortly after he joined our family, we noticed sporadic limping on his left hind leg. We had a hard time getting his damaged anterior cruciate ligament (ACL) diagnosed but thankfully Companion Pet Hospital helped us with the diagnosis and finding a surgeon. We will never be able to say enough good things about Companion Pet Hospital and highly recommend them to the denizens of Philly.

We got a double dose of bad news when Buster's left ACL was diagnosed. His right ACL was torn too. Buster needed two TPLOs! Buster is large enough (70 pounds) and active enough that he couldn't have bilateral TPLO (few dogs can). His left leg was far worse--he had started to "carry" the leg, which means he tucked it up by his side on especially painful days.

So Buster had his knee repaired. We nursed him lovingly and he healed well. At the very end of his 6 months of restriction, we learned that we were moving to California! Sadly this meant we had to find new vets and surgeons. And when your family has two cats and a dog, you need great vets, techs, and staff.

Fortunately we found some wonderful people, namely, the ladies at Tassajara Vet, who helped us find our new surgeon. Buster went for his second surgery today. This morning he visited Tassajara and we decided to start a blog about his convalescence for the ladies at Tassajara Vet. And to keep his mom sane. We'll include information from Buster's first TPLO too. Please be warned that we will show post-operative pictures, which may show swelling and bruising and may be upsetting to some readers. We apologize to anyone we offend but a dog owner going through a TPLO for the first time may find this information useful or reassuring in judging what is normal in the experience.