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12/1/00
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Cobra
first begins to limp on her left rear leg. Limp comes and goes during the weekend.
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12/5/00
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Cobra
sees "Dr. Jim." X-rays are
taken. Nothing apparent in them
related to her limp.
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12/5/00 -
12/11/00
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Cobra's
activity is limited as a soft tissue injury is suspected.
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12/11/00
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A tick
was found on Cobra's left rear leg -- the same one she is favoring. It is removed.
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12/12/00
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Cobra
continues to limp and we are now concerned about the tick and K-9 Lyme
disease. We again visit Dr. Jim. Cobra is put on Amoxicillin as a
precaution as Lyme is not a serious threat in our area. Cobra's activity remains limited.
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12/18/00
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Cobra is
allowed to romp the full yard as she seems fine! Woo-Hoo!!!
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12/19/00
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Cobra
pulls up lame again. Once again she is put on "activity
restriction."
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1/27/01
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Cobra
goes for another visit to Dr. Jim as her limp continues even with
restrictions. It has become more
pronounced and she is now occasionally whimpering in pain. The knee area remains swollen due to fluid
retention. Dr. Jim refers us to a
specialist.
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2/2/01
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Cobra as a puppy.
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Cobra
sees an orthopedic specialist. He
indicates her X-rays do show some "abnormalities that only a trained
orthopedic eye would see." The
beginning of bone spurs can be seen, as well as a "greyness" that
indicates an abnormal amount of fluid on the stifle. The joint troubling Cobra is manipulated and she reacts to this
manipulation unfavorably; however, she does not react when the same
manipulation is done on the "good" leg. This confirms for the ortho that we are dealing with either a partial,
or complete, cruciate ligament tear. Two surgical options are discussed -- one that simulates the ligament
and one called a TPLO. I leave the
office to contemplate the alternatives available to us to return the dog we
love so passionately to "rock-n-roll mode."
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2/3/01 -
2/4/01
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Mom and
Dad spend the weekend discussing what to do to help Cobra. Money is never a
topic of these discussions, but rather our focus is on what offers Cobra the
best chance at regaining a "normal" life. After a great deal of "but what ifs" and "maybe
we shoulds," as well as Internet research, we decide on the TPLO.
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2/5/01
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Cobra is
scheduled for her TPLO on 2/12/01.
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2/9/01
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Cobra's
limp worsens. She refuses to lay on
the left side, will stand with NO weight bearing on the leg, and refuses to
use the knee joint at all when walking. She either holds the leg high or
keeps the leg completely stiff when walking. THAT is an interesting thing to watch, yet painful at the same
time. How these animals compensate
amazes me!
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2/12/01
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My
husband and I dropped Cobra off this morning and spoke with the surgeon who will be performing the
TPLO. "Dr. T" was shocked at how
swollen her knee had become over the past week and asked what had happened. We discussed two instances of yelping and holding the leg up, and he
reinforced we were doing the right thing. We were told to anticipate Cobra being in surgery for approximately
3.5 hours. He also indicated that while he
considers this surgery a "big deal", it is the best answer to the
ACL problem. He also indicated they
are VERY AGGRESSIVE on pain management and reassured me that she will be as
comfortable as they can make her with pain aids. Morphine is the game plan for the next 2 days. My dog is becoming a druggie!!
Cobra was
handed over to a surgical nurse who had to worry more about Mom and my tears
then Cobra. She's never been away
from us overnight in a strange place -- her Aunt Sharon has
"dogger-sat" at our house, but she's always been in familar
surroundings.
While we
were signing the surgery consent forms, I heard her whining
and crying. The whine became a yell
and I burst into tears. The guilt
trip was in full swing!
We were
told to call around 3:00 today to check on the "Little Booger."
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2/12/01
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1:00 PM
-- Hub is on his way to pick up Cobra. Apparently an emergency involving a spinal injury came in. So -- she is now rescheduled for surgery
on 2/15/01.
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2/15/01
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I dropped
Cobra off this morning -- again -- burst into tears when I handed her over to
the surgical nurse -- again -- and just called the hospital
to check on her. She is currently in
surgery and the only status that I can get is that she is doing fine. Someone will call us when its all over.
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2/15/01
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5:55 PM
-- The surgeon calls!! He said that
Cobra did fine in surgery and the ACL tear was "partial," but
"as close to a complete tear as I've ever seen." That statement impressed me as he's performed over 600 of these
surgeries. He added that they did have problems rotating her tibia and as a
result she has incisions on both sides of her knee.
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2/16/01
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9:42 AM
-- I called the hospital. I needed to
make sure that at least someone slept well last night -- and I got told that
Cobra was doing well and could be picked up this afternoon!
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2/16/01
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Cobra is
home -- she needs to go back to the vet on Monday as they are concerned about
the swelling and they want to do a recheck earlier than normal -- yet they
assured us that is to be expected because "this TPLO was a little more
difficult than most."
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2/17/01
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Cobra and
I spent the night in the x-pen together and she whined all night. We made several trips out to the backyard
thinking that she needed to urinate, but she wasn't interested. Finally at about 7:00 AM she pee'd
a river and the whining has stopped. However, if I leave her she
gets up and stands and I am so afraid she will do damage to the surgical
site. I am concerned as there seems
to be some seeping from the surgical site now appearing on the bandage. Is this normal??
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2/17/01
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Late
Evening -- I become more concerned about the seeping seen on Cobra’s
bandages. We call the on-call Ortho
and are told to bring her to the clinic immediately. Once uncovered, the
swelling was not that bad, but she had a TON of bruising. The doctor asked whether we'd ever
known her to have the Von Willebrand’s Disease, and we said no. The bandage was changed. Everyone is perplexed about the bruising
and seeping but are chalking it up to the amount of work it took to get her
tibia rotated.
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2/18/01
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Another
day of excessive seeping. Cobra was
taken to the local emergency clinic for another bandage change. The on-call Ortho walked the emergency
clinic through the bandage change. We
are all concerned about the amount of seeping occuring from the surgical
site.
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2/19/01
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Things
are not looking very good. We made
another run to the Ortho Clinc today. Cobra is not running a temperature, yet is turning the leg inward when
she walks. The drainage has slowed,
but the surgeon’s associate said he is concerned about the way she is
favoring the leg and turning it in. We have another appointment Wednesday with the surgeon who actually
performed the surgery so that he can see her himself. I'm beginning to think
this TPLO was a HUGE mistake. We are
all running on pure nervous energy --
Cobra and I have gone nearly 48 hours without any meaningful sleep.
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2/20/01
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We now
know why Cobra is turning her leg in. The surgeon saw her today and apparently something has happened and 3
of the 6 TPLO plate screws have backed out. She needs to be re-operated on
and hopefully there are no unseen bone fractures that would inpact her
recovery. However, the specialist did say a longer and more complicated
recovery is to be expected. He even
mentioned doing some "external fixation."
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2/21/01
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We now
know more about what has happened to Cobra. Apparently the bone fractured by 3 of the screws, which is why they
backed out. She actually had two
bolts whose heads had sheared off. The surgeon is proposing a larger plate
and a rigid brace afterwards for protection. We wish we knew why this happened -- or how.
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2/22/01
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Cobra
undergoes a second surgery. The
surgeon stated her repair had to have been one of the trickiest he's ever
done and that the damage to the TPLO was much more extensive than seen on the
X-rays. She had
actually pulled part of the internal portion of her bone out. He said he
contemplated long and hard about just taking the limb while in
surgery, but didn't. He has done an
"external fixation" to make the
repair more stable and did a bone graft to promote healing. His
concerns at this time are:
Is
there something going on with the bone?
As a
result, he has sent some bone
out for biopsy. We will be waiting for the results for 10 to 14 days
Can
she remain quiet long enough to heal?
Even with
external fixation
in play, we all have that same
concern. Or, might she catch the
fixation device wrong and break her bone some place else?
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2/23/01
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Cobra
comes home -- external fixator and all.
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2/28/01
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Cobra, before her cruciate trouble.
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Cobra is
resting comfortably and doesn't appear to be bothered by the external
fixation done in the second surgery. She is walking and toe touching with that leg, standing, and sleeping
relatively well given that she's stuck sleeping in an X-pen versus a King
Size bed. I figure if I can sleep on the floor outside her X-pen, so can
she! *smile*
We are
still at a loss as to why Cobra's TPLO went so wrong. We're waiting
on the biopsy results and hoping, in an odd way, that they tell us
nothing. In an effort to try to get some better understanding as to
whether Dobermans are just not good candidates for this surgery I called
the Slocum Clinic. I spoke to a
wonderful person named Sandy
(who knows of Laurie's site) and told her about Cobra's plight.
She was
astounded -- and stated that NOTHING like this had ever happened
before to her knowledge. She
immediately suggested that possibly
there is a bone integrity issue at work here, and I told her we were
waiting on a biopsy to determine just that. She also questioned whether
Cobra was on any steriods as they could also impact her healing
process and I told her no. Given this, she felt the only other way
that Cobra could have had this much damage occur to her surgical
site would have been through a slip or fall. Sandy also noted that Dobermans are great candidates for TPLOs and it is not a "breed"
issue.
So where
does this leave us? Waiting -- for
the biopsy and some X-ray's
at 4 weeks. For now, we're just glad
to have her with us. Her
"sister," Shelby, sits next to her and licks her eyes, ears, mouth and
mumbles sweet nothings to her under her breath. Hubby and I smooch her, tell her how much we love her, and beg
her to get better. And we all wait.
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3/5/01
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This is
going to be an experience -- Cobra's bandage has now freed up her leg -- only
the external fixator is wrapped. She
had a pin come through her skin and through the bandage. *gross* And she has a minor infection at one of the fixator sites. So, she is back on antibotics. We take her up again for a recheck on
Thursday, 3/8/01, in the morning.
The
biopsy was clear. No answers to be found in that area.
Dr. T
is pleased because she's using the
leg somewhat and we've noticed she's using it more now that the bandage is
off her foot and ankle area. All good
signs.
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3/8/01
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Hub and I
had Cobra up to her ortho's again today for a follow-up visit. Things are looking better, although they
continue to monitor one of
the fixator sites for a low grade infection. The good news is that they are seeing new, healthy tissue beginning to form versus
the goopy stuff that was there before.
Her ankle
is slightly swollen, but Dr. T believes that comes from her having
the flex motion back now that the bandages are removed and her increased
use. We've been told to hot pack it 4
times a day for 10 minutes
to increase the blood flow to the limb.
We asked
about the screws and their failure being a potential culprit in Cobra's
situation. Dr. T feels very strongly
that the screws did not fail. That leaves us with a severe slip, fall,
or extreme mis-step, which he
agrees would have caused this situation to occur. The unanswered
question -- and one that will likely never be answered -- is
when/where did this occur???
We also
asked about the pin that had migrated out of her leg. We were
concerned that the integrity of the 2nd repair had somehow been compromised
as a result. We were assured this was
not the case. He anticipated
this might happen due to the severe nature of the fracture and the damage to
the surrounding tissue. As a result,
he took precautionary measures and built in implant redundancy. He added
extra pins in areas where he felt Cobra might need some added stability and
added wire to tie things together and to move and support tendons
in the healing process. The extra
pins were added in areas where the fracture was the most severe -- and it is
my understanding that this was done to assure that while some could migrate
as she moves, some would stay in place and do their job. The amount of
hardware present in the X-rays was VERY frightening in and of itself.
Her
staples from her "graft site" in her chest were removed. She goes back
on 3/15/01 for another check-up and may have the surgical site
staples removed at that time.
Amazingly
enough, we're 2 weeks away from the first set of targeted X-rays. Time flies when you're having SO
much fun!!
It should
be noted that we are seeing signs of our dog back in her behavior
-- so I know her psyche is healing.
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3/8/01
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Cobra
had a popping sound occur in her leg
at approximately 7:30 and after a few hours is refusing to use the TPLO leg
at all. Around 2 AM she tried to get
up, lost her balance and tried regaining it by using the TPLO leg. She let out a HUGE LONG yelp.
I
immediately called the on-call surgeon who luckily knew her case. He said I am to get her up to Concord
first thing in the morning as he believes she is in serious trouble. Based on prior feedback from Dr. T, if
that is the case, we may be faced with putting her to sleep.
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3/15/01
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Cobra 's
popping sound ended up being related to her external fixator. Apparently a bracing pin was beginning to
fracture and that was why she began refusing to use the leg. The smart little booger knew something
wasn't right. When she lost lost her
balance at 2 AM and let out the HUGE
LONG yelp it was at that time the pin at the very top of the fixator, in her
femur, fractured in two.
The good
news is that nothing in the repair was compromised. The X-rays showed that, and also indicated that some bone healing is taking
place. She is currently at the
clinic undergoing another small surgery to replace the pin. We should be able to get her later
tonight.
Apparently
we dodged another bullet.
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3/16/01
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Cobra
came home late last night. I'm beginning to wonder if we'll make it through
this -- she didn't sleep at all last night -- and that means I'm
running on 4 hours of sleep in the last 2 days.
Not good. She doesn't deserve this.
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3/18/01
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Cobra is
reluctant to use her leg since the pin fracture. It pains me to watch her hobble on three legs again after all
she has been through. The orthos are saying Cobra will have "reasonable
function" of the leg -- whatever that means. She has some blood coming
through her bandage so we're going see if we can get her to the clinic
tomorrow for a bandage change and at that time I will be asking about her
reluctance to use the leg.
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3/19/01
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Cobra’s
bandage has been changed and no one seems concerned about her reluctance to
use the leg. In fact, they are a
little relieved that she doesn’t want
to use it. The belief is that she was using the leg too much and the pin
fractured under the stress. Apparently not many dogs use the leg when they have an external fixator, as the pins into the bone from
the fixator are "uncomfortable" for them. Leave it to Cobra to be an exception!
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3/22/01
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Cobra is
doing better. She currently at my
feet sound asleep. She looks so pain
free when she sleeps. :)
She's
starting to use the leg a little more, but it varies from day to day. After all she's been through, I don't
blame her for not wanting to use it. Cobra gets checked out again this
Friday, 3/23/01. We'll do a bandage
change and one of the Ortho's partners (the operating surgeon has this week
off) will review her progress. While
I'm remain anxious because she isn't using the leg like I would like again,
I'm also getting pretty resigned to the fact that her healing is up to her
now. I can help -- but I can't make
her better. Only time and rest can. It's really up to Cobra now and I suspect that may be why she's
"soft peddling" the leg. She may have finally realized that she was being her own worst enemy.
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3/23/01
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Cobra’s
latest appointment went well. The fixator is now nearly 100% exposed *shiver*
so that the drill holes (I don't know what else to call
them) can start to dry out and air. The covering vet said he is very comfortable with how she is using leg
and was surprised when I told him how she'd been using it more before the pin
snapped. He too thinks maybe she's
finally learned to stop being her own worst enemy.
The
latest "milestone" will be two weeks out -- fixator removal. That step is pretty scary because the
fixator has been supporting the fracture and its healing process -- but it is definitely heading in the right
direction. I'm just so frightened for
her not to have the extra support -- yet I want the dang thing off so that I
can get her into swim therapy.
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3/27/01
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A new
worry hits me. Cobra’s knee will have
been immobile for nearly 8 weeks. The
atrophy will be tremendous. How much
use will she be able to regain? Her
road back will be long -- and hard.
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3/28/01
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I feel
like pulling my hair out!!! I just took a look at Cobra's leg to see if I
needed to put any Neosporin on the fixator sites and realized she has another
reconstruction pin migrating through her skin!!!! Gosh
darn-it!! What next?!!
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3/29/01
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Cobra got
past another scare. (I'm beginning to think she likes this!!)
Apparently
the pin migrated out for the same reason the eariler one did -- tissue
movement. However, this one was not
extremely loose so Dr. T gave her a local, slipped the pin out a little more,
shortened it, and shoved it back in under the skin. There is some critical
wire attached to this pin and he didn't want to lose its benefit just yet as
her last X-ray's didn't reflect enough healing having taken place.
Our next
"planned" appointment is in a week. The plan is to sedate her, remove the outer portions of the fixator,
get X-rays, and if things look good -- the fixator comes off. That would
allow us to then get into some therapy for the knee joint.
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4/4/01
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FINALLY
-- Cobra is without the fixator! She had some great bone healing
take place over the last 3.5 weeks. Dr. T has braced her leg with a rigid
splint and bandaged it from toe to thigh again. He cautioned us that she can not use this leg unassisted yet --
but we’re heading in the right direction!
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4/5/01
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Slightly
after midnight -- Cobra decides to test the leg alone in her X-pen. Apparently she stepped wrong. She has
fractured the leg again.
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4/5/01
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Slightly
after 8:30 AM -- Cobra is clearly telling me that she doesn’t have the
strength to go through another bout of reconstructive surgery. Rather than making the long drive, with
her screaming in pain, to the Orthopedic Speciality Clinic -- we chose to
make the short drive to Dr. Jim's. With tremendous kindness, and a heavy heart, we loved Cobra and wished
her well as she began her journey to the Rainbow Bridge.
Love your
furry friends -- relish the time you have with them. It passes all too quickly.
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