7 weeks 6 days post surgery

I meant to write an update after his 6 week xrays and recheck, but we've been too busy doing stuff!

Before xrays.

Diego's xrays showed "excellent bony fill" of 2/3 joints we want to fuse. The remaining joint "is beginning to fill with hypodense bone at this time" and the surgeon expects this to "continue to fill in without complication." Those are really, really good words to hear 6 weeks post surgery! His surgeon and rehab vets agreed that he was ready for the next stage in recovery!

After xrays.

Water therapy!

Not thrilled. But cooperative. 

Diego will be walking in the underwater treadmill 1-2 times weekly. He is now in a Therapaw brace, still with a thermoplastic splint. This brace is easy to put on and take off, unlike his bandage with a splint! He still isn't allowed to walk on his leg without the support of his brace, or the water, but this means he gets time out of his brace now when we're relaxing at home.

New brace with splint.

He had his first water therapy session last Thursday. While he didn't love it, he did walk well in the water for me. And he ate the whole time (I can gauge the level of his stress by whether or not he will eat treats) which was really good!

Cuddle time means no brace needed!

His rehab vet has us doing more exercises at home now too. Keeping the remaining joints moving well is one of our biggest concerns so I do range of motion exercises on his shoulder and elbow. And we have started stretching his toes. They were pretty stiff from being stuck in one position for 6 weeks.

He gets to chew bones again. He is oh-so-happy!

We had to add a stronger anti-inflammatory for a couple days with the switch from a bandage to the brace. But he's back to his regular schedule of medications again.

Walks have continued to increase in time based on how comfortable he is (and how much good footing I can find outside, we do a lot of walking in the hallway) up to about 15 minutes now. He also has free reign in the house again.

Xrays will be re-taken around 10 weeks with his final recheck with the surgeon. And from there he will continue rehab slowly and steadily under the guidance of his rehab vets. The process has been long (and it's not over yet) but so very rewarding. He is so much more comfortable than he was before surgery. We are so thankful that this experience has been possible. Thank you from the bottom of our hearts to ESRA (especially Clayton Nation), Twin Cities Animal Rehab, Blue Pearl, and all the people who believed he deserved a second chance.

Medications and Supplements

I've mentioned the medications Diego is on before, but since so many of them are recommended for "older dogs," I want to share a little more about them.

All of Diego's medications are prescribed by a veterinarian. All of his supplements are recommended by a veterinarian, but they are available over the counter in most cases. I am fortunate enough to see the positive effects of these products in client dogs, as well as my own.

Adequan
Adequan is an injectable joint supplement. It is not injected into the affected joint(s), rather just under the skin. Most dogs don't even notice the needle prick. From their website: "It helps keep the cartilage healthy and intact, so that the bone in the joint cannot touch other bone." There is a loading dose given (more frequent injections) and maintenance is usually every 3-4 weeks. Diego does best with every 3 week injections.

Boswellia
The product we use, sell, and trust at work is made by Standard Process. From their website: "We take measures to ensure product quality every day. We follow strict guidelines to grow the great majority of our ingredients on our own certified organic farm and perform repeated testing through the manufacturing process to ensure the quality and safety of our supplements." Boswellia Complex works as an anti-inflammatory, supports normal function of the kidneys, maintains and supports joint health, and provides antioxidant activity.

Dasuquin
Dasuquin is an oral joint health supplement. From their website: "Dasuquin is a dual synergestic formula: its specific glucosamine hydrochloride and low molecular weights chondroitin sulfate have demonstrated synergy in stimulating cartilage matrix production while ASU also acts synergestically with glucosamine." Nutramax products have also been tested (and approved) by Consumer Labs, an independent testing facility. What they say is in the product, is in the product.

Gabapentin
The use of Gabapentin (Neurontin) in dogs is generally to treat nerve based pain. Diego was started on Gabapentin prior to his surgery because we know he's sensitive to some medications. We wanted to make sure he could tolerate the Gabapentin, as well as prevent wind-up pain. "Wind-up pain is a heightened sensitivity that results in altered pain thresholds, both peripherally and centrally, such that pain is experienced in areas unrelated to the original source. Wind-up causes a worsening of acute pain." He tolerates the Gabapentin well enough that he's been on a high dose since we took his Fentanyl patch off that was placed during surgery. We attempted to wean down his morning dose a couple weeks ago but there was a noticeable decline in his comfort.

Phycox
After we discovered that Diego didn't tolerate Metacam (vomiting and diarrhea), we looked for non-steroidal anti-inflammatory (NSAID) alternatives. Phycox has a couple products, but the MAX was chosen for Diego because of his age and condition. Phycox MAX has "increased anti-inflammatory activity with greater analgesic effects (pain relief)." He has been on the Phycox since July and I noticed a big decline in the amount of time he spent licking his right carpus within the first month of being on it. I had never used this product before, but I have been very pleased with the results.

Welactin
Welactin is made by the same company as Dasuquin, Nutramax. EPA, an omega 3 fatty acid, has been shown to decrease the inflammatory response when given at high doses. Welactin has a much higher concentration of EPA than other omega 3 fatty acids available, so I have to give less to get the desired result. I also trust the product because it is made by Nutramax.

There used to be a theory that not giving dogs pain medications after surgery made recovery smoother, because the dog self-regulated activity then. Now we know better. Wind-up pain, mentioned above, inhibits effective healing. Diego is on a variety of medications and supplements because it is important for him to be as comfortable as possible while healing. The less pain he feels, the more he will use the rest of his body in a normal fashion. One of the most difficult parts of recovery is making sure the rest of the body continues to move fluidly so that he doesn't injure something else (generally a muscle) due to compensating.

 It is very unlikely that Diego will continue to be on all of these medications for the rest of his life. We assess his pain level on a weekly basis to determine whether or not we can start weaning him down. So far, he hasn't shown us that he will be comfortable without the amount of pain control he currently has.

4 Weeks Post-Op

On December 31st, we celebrated that Diego is 4 weeks post surgery! His original surgery date was November 19th, but on the 17th he developed a nail bed infection on his right foot. Infection is one of the biggest complications of any arthrodesis procedure so we certainly didn't want to start off that way! He had two weeks of antibiotics and we took another set of xrays to make sure nothing else was going on. Luckily, he responded to antibiotics and there was no change on his xrays.

Thursday night

So, on December 3rd he had his right carpus arthrodesed by Dr Andrew Jackson at Blue Pearl. The surgery report said that surgery was a success. He spent the night there for 24 hour monitoring and some extra good pain medications. I picked him up the next evening and the poor guy was pretty sore and out of sorts. Once we got home and settled though, he slept really well.


The first few days were quite a challenge. He had surgery on Wednesday, I picked him up Thursday night after work. Friday morning he woke up with a very swollen upper arm. I don't have a whole lot of experience with bandages yet, so I brought him to work with me. Dr Amy Whaley examined his leg and started us on this bandage adventure successfully!

Friday morning at work

Swollen and bruised

1) His leg was swollen because of the pressure of the bandage. It happens with bandages. We removed his bandage, iced, and air splinted his leg to help reduce the swelling. Due to the amount of bruising and swelling, he also received a laser treatment.

2) We discovered that the splint under his bandage wasn't as smooth as it could be. This was likely causing some discomfort so a new one was made out of a different material that is smooth to start with.

I spent the next few days removing his bandage and repeating the air splint, ice, laser routine. Then rebandage. Diego became a model patient, even with frequent bandage changes. He learned to lie on his side on the table and let us work on his leg without an issue. The most common sight during a bandage change is Diego lying on the table with his eyes closed and his tail gently wagging.

When I first got Diego, he didn't trust me, or anyone really. While I would never wish this on a dog just to get where we are now, it has really helped me develop a working relationship with him. And it has built trust we needed to get a working relationship.

Air splint!

Diego will let me do just about anything to him. This is such a change from when I first got him, when he didn't even want me to pet him. Sometimes he still gets worried (like when we had to use the forced air dryer on his foot) and I need help, but overall, he has come so far in his handle-ability. I really never imagine he'd be this good. I never thought that a dog who disliked being handled so much would fall in love with his first technician at Blue Pearl. Or allow two people at my work to change his bandage without me. But he continues to surprise me.


Now that we are four weeks post surgery, his bandage is only being changed every 6-7 days and there hasn't been any swelling.

He is happy because he can use his peg leg well enough to hold bully sticks again!

This has been a huge learning experience for me, and I am so happy to report that he is healing right on schedule. Diego has helped me learn how to be a better Veterinary Technician. I am not a bandage master, but I can certainly bandage a leg with a splint now!