Rest Easy Good Boy

Many people have expressed interest in knowing more about what Diego has been through since October. Most of the people reading this know what has gone on prior regarding his front legs. Below details why Diego was euthanized. If you have questions, I will answer them, but please be kind. I adored him as one of my own, and I will miss him always. He made a huge impact on me in the year and a half I loved and cared for him. Since every dog in my care ends up with a registered name, he got one as well.

ESRA's Go Diego Go

February 13, 2002-November 20, 2015

In October, Diego presented with a quickly progressing inability to eat with temporal and masticatory muscle spasm (the muscles over the top of his head and where his jaw hinges). We treated as Masticatory Muscle Myositis, as that seemed the most likely cause. He responded well for a couple weeks. Then he had a sudden worsening of symptoms where he had discharge from his left eye, nostril, and ear. He wouldn't eat even being hand fed, so I was force feeding him and syringing water into him. He hadn't really been soliciting attention lately, at least not in the same way he used to. Diego used to follow me everywhere and plop his head in my lap for petting, or rub happily on me if I didn't have any available hands. I can't remember the last time he did that.



Waiting at Blue Pearl, something we did a lot of.

He was seen by a dental specialist for full mouth sedated xrays, hoping we'd find an abscessed PM4 (the big tooth on the top with 3 roots that can be responsible for the symptoms he was exhibiting). Unfortunately that wasn't the case. He was sent home with steroids and improved rapidly, for a short period of time. We unfortunately suspected a brain tumor that was steroid responsive.

Friday, November 13, I rushed him to the specialist again as he wouldn't eat, wouldn't drink, and could barely stand up. When he did, he circled, usually to the left. The neurologist evaluated him and agreed that we are likely facing a tumor with a very poor prognosis but we could try to improve his quality of life with a higher dose of steroids. She also suggested we try two antibiotics he hadn't been on yet, just in case it was an infection somewhere.

Diego made a dramatic improvement from Friday to Sunday. He was back to his happy, bouncy self! Eating, drinking, and wanting to interact with me.

Monday and Tuesday had ups and downs. We went for walks, I carefully managed his front legs, and we tried to just celebrate feeling good when he did.

Wednesday night I got home from work and gave everyone their meds. Diego ate his dinner first then I fed the others while I worked on his leg. He has been wearing a removable brace for the last week or so, in place of the bandage and splint he had been in. Every day, I would take the brace off and check his leg in the morning and the evening, looking for redness, letting it breathe, and then applying ant-friction powder before putting his brace back on. On Wednesday he laid on his side like I asked, he let me take his brace off without an issue. While I was examining his right leg he sat up quickly and bit my right hand. He didn't let go. He wasn't responsive to cues. I had to drop food on the ground to get him to let go. This was not Diego. I sat on the floor and cried. He seemed to return to normal rapidly, but it was brief. And then we had two more episodes that night where he had to be handled carefully and was unresponsive to cues. When I consulted with his specialists, they agreed, this was a progression of a tumor.

Diego was humanely euthanized in my home after we had tried everything that was in his best interest. He received the best medical care I could find. We managed his pain, he saw specialists, we made every decision as best we could for him. And when we could no longer help him, we said good bye for now. Diego was not euthanized because he bit me.

I choose to remember Diego as the sweet, funny, happy boy I grew to love. I hope everyone reading this can do the same. I don't blame him, and I don't blame myself. It was an awful situation that forced me to make a decision in his best interest.

Rest easy good boy, good bye for now.

Thanks to English Springer Rescue America for doing everything possible for one of our own. Thank you to everyone who donated to his care, kindly lent an ear when I needed to talk, and those who cared about this little black and white Springer boy.

Proud.

On Friday March 20th, Diego showed me that the months of work we have done really has made a difference. A huge difference. Not just in a training situation either. He was actually relaxed while we casted him for his orthosis (a custom made brace for his front left leg, to support it because he has carpal hyperextension). It involved standing up and having measurements taken of his legs, testing the degree of collapse in his left wrist (which was painful), and lying so very still while the cast hardened. He let Dr Julia and I do all of this without a single lip lift, growl, or snarl. He lied quietly on his side and when he wiggled, stopped when I asked him to. The video we sent OrthoPets of him moving around the room shows him relaxed and comfortable, despite something very different going on.

Orthosis casting day!

Diego's consultation at my work was... not pretty. He was worried about everyone and everything. His consult was done not long after he came to live with me so we could determine the best plan for him. We had to forego a lot of it because he wouldn't allow it. Either by thrashing or by stiffening up so much we couldn't get very accurate measurements of his limbs. Most dogs we see are a bit nervous, but are with a person/people they trust. Diego didn't have anyone he trusted yet.

Whenever I sit down I get a dog on each side.

Nearly every day since he arrived at my house, I've done some sort of handling practice with him. And every day even though it was paired with food, I felt like he was getting worse instead of better. This went on for months. I'd see a little improvement in his handle-ability but not in how he felt about it. I don't know what his life was like in his previous home. Based on the behaviors I've seen from him, I suspect he didn't have much structure in his daily life or interaction with strangers. He is not a fearful dog in the general sense, but he also didn't appear to have the trusting nature of a typical springer. The more I got to know him, the more I realized his extreme reactions were all related to him feeling like he had no control over a situation.

He wants to learn how to drive now!

So I started making it about massage and relaxation under my hands instead of offering behaviors for food. The change was not immediate, but I saw progress. Consistent progress. He really likes massage, he will flop on his side and lie very still while I work my way from his head to his tail. When I need to roll him over to work on the other side, he just stays limp.

When I made my handling about massage, I saw progress in our sessions at home. I could handle him confidently. We started making progress on "collar grabs" which used to be his biggest trigger. And now he routinely leans on me (literally) out in public.

It took me a while, but I finally remembered the lesson from Ruca.

Learning to track

He's not "fixed" and he isn't perfect. But he looks to me when he's worried about a situation and trusts my judgement now.

I am so proud of him. And I can't wait to see what the rest of his life holds for him.

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!

November 19th

In the last month, Diego had an exam by a different type of specialist (a surgeon this time) and continued care with his rehab vets. I would like to thank Dr Jackson of Blue Pearl and Dr Tomlinson and Dr Whaley of Twin Cities Animal Rehabilitation and Sports Medicine for their time and dedication.

Diego is currently on one medication and a handful of supplements to alleviate as much of his pain as possible. We recently added a new medication and altered the dosages of his other meds recently. He had started lifting his right front foot up while standing again. One of his rehab vets had us increase his anti-inflammatory, Boswellia to being given twice daily. When just that didn't do the trick, we added in a new prescription medication that helps with nerve based pain. Diego is now flying around my apartment as much as I'll let him. He is standing up again instead of preferring to lay down. And he's back to being his very agreeable self.

During his consultation with Dr Jackson, we received some challenging news. Due to the further break down of Diego's wrist (despite my diligence with his care), Dr Jackson believes that our best chance of getting Diego pain free is to perform an orthopedic surgery (arthrodesis) that would fuse the bones in his wrist together and use a metal plate to stabilize. This is the option I wanted the least. It scares me because of the higher incidence of potential problems after the surgery. However, Dr Jackson has many years of experience, and many reasons why this surgery will give Diego the best outcome.

1) Without very advanced imaging, we can't ensure that all of the tiny bone fragments are removed (our original plan). Removing some of the fragments, but not all, may mean the really painful ones will still remain. We don't want this because we'd be in the same place we are now.

2) Diego has evidence of break down in his left wrist as well. Even if he were to be in an orthotic 80% of the time, he would still be putting a lot of weight on his left wrist. After he is healed, he should use his right leg more than his left because it will be non-painful.

3) Dr Jackson believes so strongly that this is the best option for Diego that he reduced the initial estimated cost by almost 50%.

So, Diego is having surgery on November 19th to fuse his right wrist together. He will spend the night there so they can administer very strong pain meds and monitor him after the procedure. He will then be in a bandage for 12 weeks (with weekly bandage changes) while his leg heals. During this time he will be able to go on very short leashed walks a couple times a day. He will need to be kept as quiet as possible to ensure the best possible outcome.

Diego and I thank you for your support!
Diego also thanks ESRA and his spectacular veterinary team. Last but certainly not least, he also thanks all of his fans!

Diego's Wrists

Diego has a very painful wrist and a semi-painful wrist. His right carpus (wrist) is swollen, it is hyperextended (stretches further than it should), and it hurts. He licks at it a lot, which tells me something is uncomfortable. He is missing hair in two places from licking. He protests me handling it. He chooses to lie down instead of sit or stand for long periods of time. When he walks, he limps. His left carpus is also hyperextended.

Bailey, Gabby, and Diego waiting in the elevator.

After his exam at my work, one of the recommendations was to get his front legs xrayed. So Monday morning, we xrayed Diego's front legs. Tuesday the xrays were read and it was determined that he had an untreated fracture in his radius (the big bone at the front of the foreleg, below the elbow, close to the carpus) with bone fragments present. This is likely the root cause of his pain. And we needed to talk with his rehab vet as well as a surgeon to determine the best possible outcome for Diego to be pain free. Two surgeons generously read Diego's xrays and told us their respective recommendations.

Waiting for his exam. Note the hairloss on his wrist.

So now we have a few options.
1) Surgically remove the bone fragments in his wrist then brace it externally with a custom orthotic from OrthoPets. Removing the fragments should give him pain relief as one of the surgeons said the fragments are likely pinching his tendons when he moves, causing damage and discomfort. However, he would still need support of his wrist after the surgery.

One xray view of his wrists.

2) Surgically remove the fragments and fuse his carpus joints together (arthrodesis). This is not a guaranteed fix and is very expensive.

The other view of his wrists.

3) Continue with pain medications and other anti-inflammatory treatments (specifically laser therapy). He is definitely more comfortable than he was, but he is still bothered by it.

We are currently trying to decide on the best option for Diego. We should know soon.

Diego and Gabby. Neither wanted to pose for me!