| Kramer's story | |||||||||||||||||||||
|
Owner: Susan E-mail: AuntieSnickers@aol.com Date posted: October 8, 2000
Even as I type this, he is in the recovery ward at Angell Memorial in Jamaica Plain (Boston), having had a TPLO done by Dr. David Diamond, a board-certified veterinary surgeon who specializes in orthopedics. Dr. Diamond did not even give us an alternative procedure. Based on Kramer's weight and activity level (high, high, high) he felt this was his only valid option. Of course I cannot comment at this point on recovery, but I am hopeful that all will go well. I do have five steps to get into my apartment building -- my landlord is going to try to build a ramp for my dog, but I may end up having to attempt to carry him, although that may be more dangerous for both of us!
I pick up my dog tonight. If anyone is interested in communicating, I would welcome your e-mails. UPDATE: October 10, 2000. Kramer is now one week post-op. Tonight I came home from work and was shocked to find his leg much more swollen than it was this morning. I raced to the phone to call the surgeon's office, and was happy to actually get the surgeon on the phone. He has been wonderful! He was not overly concerned. He suggested that perhaps Kramer is doing more with the leg than it seems (I don't think he's using it at all). He did tell me I have to stop him from jumping on the bed. I must add that Kramer also had part of his tail amputated ... but not enough I guess, because he spent today nibbling off the end of his tail bandage and pulling out all the gauze and stuffing. He is wearing an Elizabethan collar because he was licking his staples and chewing his tail bandage, so perhaps the contortions he had to do to work on his tail today were enough, or maybe something got him excited today while I wasn't home. Who knows. He's not talking! The leg does seem painful, and as I said, is very swollen. The surgeon said to use hot compresses three times a day, and if it gets worse to call back for some antibiotics.
Update: October 22, 2000 It has been 19 days since Kramer's TPLO. At day 11, I was full of hope when he started taking a few steps now and then on his "bad" leg. He'd take four or five steps and look pretty pleased with himself. I took him to have his staples out on day 14, and since then he hasn't used his leg at all. I wonder if my bumbling efforts to get him into my Honda CR-V myself caused an injury. Or, did the vet or one of his technicians do something? I hate it when they take your dog away to perform a procedure! The vet who removed the staples told me he felt Kramer was doing well, and that he was putting some weight on the leg. But since that evening, he has only probably put his leg down once a day or so. And never for more than a touch, or to maintain balance. I have called the surgeon three times, but have only spoken to his "nurse." She told me to call on the 23rd if he showed no improvement over the weekend (he has not).
I have left word to have the surgeon call me ASAP on Monday. I must say, Kramer does not appear to be in pain. There is no unusual swelling, his appetite is good, but he is sleeping a LOT. Could this all be because we quit the Rimadyl at the same time as the staples were removed? Update: Week Three I have been worried sick. Kramer started using his leg on day 11, but stopped using it on day 14 after having had his staples removed. After many frantic phone calls, I was able to get an appointment to see the surgeon (who is supposed to be out on vacation, but could not manage to cancel his appointments!). The surgeon pulled and twisted and prodded Kramer's leg, and found no problems. My fearless pooch showed no signs of pain, but did hop off and hide under the desk after the exam. The plate is secure, the bones are aligned the way they should be, and there is no sign of infection. The surgeon did say there was more swelling than he would expect at this stage, but he was not very concerned about that, so I will try not to be either.
I asked Dr. Diamond about some of the stories I've read where people whose dogs have undergone TPLO surgery are being allowed at 3 and 4 weeks to take walks, have free run of the house, etc. He was shocked, and told me in no uncertain terms that those were not things he would approve of. I asked why Angell Memorial's TPLO discharge instructions call for 10 weeks of confinement instead of the typical 6 to 8 weeks, and he said they were just more conservative. Clearly my dog is not going to be ready for rehab in 6 weeks if he isn't even walking on his leg at 3! UPDATE: November 17, 2000. It has been a full six weeks since Kramer's TPLO surgery. At this point, he is off Rimadyl and on Ascriptin twice daily. He is still in pain, and there is still some swelling directly over the metal plate. I wonder if he isn't having a reaction to the plate? Despite my serious concerns, the surgeon says that while it is not common for a dog to be experiencing discomfort at six weeks, it is not so unusual as to concern him.
He has always been a high strung boy, and maybe he needs a doggy shrink to deal with the pain. I am at a loss myself! I simply continue to follow doctor's orders, and have allowed my dog no exercise at all for the past six weeks. He is still in an exercise pen all day, and allowed to be free when I am home (I have a three-room apartment, so "free" is relative). We are traveling to Nantucket for Thanksgiving, on a plane. It will be quite an adventure. My parents have two dogs, and my brother is bringing his dog. Kramer will have to be confined in a bedroom in his pen, as these three dogs are his best friends, and there is no way I am going to risk him injuring himself at this stage by playing. UPDATE: February 26, 2001 Twenty weeks after Kramer's TPLO, I had him x-rayed again. Incredibly, the bone fracture has not healed. There is a small area of "calcification," but even I, a non-radiologist, can see that the bone ends did not knit together. Also, sadly, there are "arthritic changes" in his knee now. Keep in mind his surgery was 5 days after his injury. The changes have come AFTER the operation. Ironically my regular vet is sending the x-ray films to Angell, where the surgery was performed, to be evaluated. She didn't have much in the way of good news for us, and advised me to continue with leash walking only for exercise. It is depressing news to say the least. Kramer is a happy dog, and I am doing everything I can to keep him happy and entertained, but to be just six years old and to have almost everything he enjoyed in life taken away seems so unjust. On the plus side, he can walk on all four legs--and he couldn't before the surgery. I suppose the result is better than hopping on three legs, but not what I had hoped for, and certainly not what I was led to believe I could expect. No one has given me a single answer on why my dog's leg has failed to heal, so I can only wonder. Should his other knee go, I will NOT have another TPLO done. It was far too painful for Kramer. I don't know if there is something amiss with his metabolism, or if his bones lack something, but we will not go through this again. UPDATE: February 27, 2001 Upon forwarding Kramer's films to Angell, Dr. Diamond (the surgeon) is suddenly very interested in Kramer again. They want to have him back in for a full set of x-rays. They are worried, and also have not seen this before. They think perhaps he has an festering infection. I would think he would be ill if that was the case, but ... I'll send an update when I have one. UPDATE: April 10, 2001 Good news, at last! Six months and one week after Kramer's surgery, he had a third set of post-TPLO x-rays done. Finally there are signs of progress! The doctor said his bone is about 75% healed, and Kramer can start some mild off-leash activity. Having just returned from the park, I can tell you all he is ecstatic to be "on parole." His gait is not the same, and I'm sure it never will be, but he got around just fine and is not in any pain that I can see, although I imagine he'll be sore tomorrow. We were advised to give it a month of gradually increasing activity before he can return to his normal life. The vet said, "I personally guarantee the plate will hold the graft together." So I asked if he would repair it for free if it didn't--and he laughed. Hopefully this ordeal is over! Susan (Read on below for a September 2001 update on Kramer's post-surgical woes, including a second surgery to remove the metal plate that was installed during his TPLO.)
Saturday night: Kramer has suddenly got a terrible limp. I assume he over did things at the park and decide to force him to rest for a week. Sunday morning: Kramer seems more than lame, he seems ill, but I can't imagine what is wrong. I don't feel it is an emergency, but I am very concerned and determined to get to the vet first thing Monday morning. Monday morning: Kramer looks like he wants to die. His eyes are dull and lifeless. I can tell he has a fever just by touching him. He won't use his TPLO'd leg at all, and screams in pain if I touch it. I call the vet, and they tell me to come in. When I tell the vet that the affected leg is the same leg that was operated on nearly a year ago, and that an infection had been treated six months ago, she tells me immediately that she wants to admit Kramer. I am so upset I can barely think, but of course I agree. His temp is nearly 105. He doesn't even care when they lead him away from me. The admitting vet is only part time, so she tells me another doctor will call me later in the day. Monday afternoon, I hear from Kramer's "regular" vet, Dr. Teague. They've taken x-rays and also spoken to a veterinary orthopedic surgeon from Tufts. The surgeon feels that the infection is severe, and that the joint needs to be tapped to tell exactly what kind of bacteria is in it, and also that the metal plate in Kramer's tibia needs to come out, as on x-ray it appears to be the source of infection. I agree to everything. Kramer is on IV antibiotics, and wagging his tail like mad at everyone who walks past him. I decide not to visit, as I feel it will only confuse Kramer. Tuesday: Dr. McCarthy from Tufts opens up Kramer knee and finds massive infection in the joint capsule. They clean it out, and also remove the metal plate. One of the screws holding the plate to the tibia has snapped off, and he does not dare leave it in the bone, so he has to dig it out. It takes him a LONG time to get the knee clean and all the screws out.
When he gets home, I remove the E-collar. Kramer doesn't need that. His x-pen is ready to go (glad I didn't get rid of it!) and his cats are very curious about the funny blue leg on their big body guard. He cannot get up the steps to go outside worth a darn with the cast on, so after the first day I remove it. It takes me a full fifteen minutes to cut through the thing, and the pile of gauze, cotton, and vet wrap is larger than my cats when I am finished! Kramer falls into my lap, wiggling and kissing me after I take the cast off.
A few days go by, and the vet calls. They have the results of the bacterial culture. Kramer has a staph infection which is resistant to some things, but can be treated with Baytril and Clavamox. Kramer is going to be taking these two medications for six to eight weeks. I am to come pick up a supply (they sent me home with a week's worth of medications, one of which is no good for this infection). I pick up the drugs and nearly pass out: $250 for a month's worth. My parents kindly picked up the bill for this operation, which cost $2,200. The surgeon and the "regular" vet both feel that this infection is the same infection which Kramer was treated for six months ago. No culture was done at that point, and Angell did not suggest any follow up after a course of four weeks on Keflex. The only thing that was done was a third (or was it fourth?) set of x-rays, which showed only "75% healing" of the bone.
I know no surgery is risk free, and infection is certainly something you might expect. In human joint replacements, this sort of year-long delayed infection happens. It just wasn't anything I was warned about. Being over $5,000 in the hole doesn't make me happy either. Sure, Kramer is worth it, but I don't think from what I've read on the 'net that vets are giving us adequate warnings about the risks of the TPLO. Kramer is doing pretty well now, a month post surgical the second time. His is tolerating his pile of pills well, but is going out of his mind from the confinement. Thank God for the cats to entertain him!
|
