ACL Surgery The Second - Part II - Long Recovery

Well, I'm nearly back to normal now - which is to say I want to be back to normal but if I play too much you can tell it make my knee sore - so I figured I should finish up the ACL saga.

The Rest Of The Story

Initial recovery was pretty rough. I've never had a cast on and it was hard to figure out how to walk around. For several days my people kept me on my bed most of the time and carried me out to potty. They were very vigilant - Daddy even took days off work. Someone was with me all day long to make sure I didn't try to move much and to help me shift around or get water or eat. One are of concern, of course, was that I wouldn't potty anywhere but on the hill, so they would take me out and plop me by a shrub on the hill and I would pee. I tried to walk some, but for the first couple of days I just fell over a lot so it was straight back to bed. Pooping was a whole different situation. For a couple of days I just didn't do it. Part of that was due to the drugs and surgery, but part of it was that it's just hard to squat when your knee is immobilized. Eventually I did figure out, much the humans' relief. Part of the problem was the painkillers. I was very drugged for a week or so, and then gradually less drugged until the two week mark when I got my cast removed.

I actually got pretty good at walking around on the cast both inside and out. I could walk on slick floors or carpet, I could walk up and down the hill, and I even managed to get on the couch once when no one was looking. They called me "Peg Leg" and made pirate sounds.

So, like I said, after two weeks we took another trip to the doctor and off came the cast. Mama said I've cried so loud in my life. Other people in the waiting room looked shocked and concerned. But when it was over I was fine and bouncy and happy to be done with it. But the ride home was painful and it was a rough couple of days until I figured out how to walk sans peg leg again. I did have to wear the cone again for quite some time. I wanted nothing more than to lick the big jagged scab on my leg, but they wouldn't let me. The scab finally went away and they took that awful thing off me.

Two weeks later was another checkup, and everything looked swell, but the Doc said I should keep my activity low til Thanksgiving or later. And I've been slowly getting crankier and crankier because I want to run and play and I want to go outside with Milo and I want to jump on the furniture. My people have finally started letting me on the couch, and I get on the bed most mornings now. I can even go outside on my own again, but this nice potty schedule I had going when I went out on the leash is all mucked up now. We've started short walks to burn off some steam, though it's not working very well because I have too much steam. I've been barking and getting into trouble more. I just have too much energy.

All-in-all this recovery probably wasn't/isn't much worse than the first time around, but it's been harder keeping my activity level down for so long. It's very important, though, that we increase activity slowly. Anything that causes obvious discomfort needs to be cut back. There are no big leaps in condition after knee surgery and it's very important to remember that and take things slowly. That doesn't mean I won't try to run laps around the house on a daily basis, but it does mean my poor people have to pay extra close attention to me and slow me down when I start to get crazy.

Everything seems to be going well, and hopefully this is the last I ever have to think about my knees ever again. And with any luck I'll be ready to start hiking again come spring.

-Kobi

Left: Mama or Daddy was right there for the better part of two weeks.
Right: Special arrangements were made to make eating easier.

ACL Surgery The Second - Part I - The Other Knee

I'm still recovering, and it's a nasty cold, wet, and windy day out, and I've been putting this off for a bit. But, I guess, it's finally time to write about my second ACL mishap. This one was different because, as best we (and the vet) can figure, it actually happened over a fairly long period of time.

The Rest Of The Story

Off and on, like any dog, I do something dumb and hurt my foot or my leg and limp a little bit. This, of course, causes great consternation amongst the humans, so any time I had a limp, favoring one leg or the other, they were sure I'd thrashed my "good" knee, or re-thrashed my "bad" knee. Usually, things improve overnight or after a day and it's nothing. But in early summer this year I was doing fine and then, for no apparent reason, I couldn't put weight on my "good" (left) back leg. I would try, but it would kind of slide underneath me. But after a while, it seemed to fix itself. Then not more than a day or two later it happened again, and again fixed itself. I was headed to the vet for my annual checkup anyway and when Mama asked about knee they felt around and made awful crunching noises and said, "He has a luxating patella."

For those not steeped in medical terminology, that means your kneecap slips to one side or the other (or both). It's supposed to move smoothly up and down in a groove in the femur bone with the patellar ligament holding it in that groove (see the pics from my previous post for visualization). When the knee cap comes out of that groove, it's like a "trick knee" in humans, you put weight on it and it just goes any which way and you fall down. Of course, we dogs are built better than humans, we still have a tripod to stand on if one leg goes down so we don't usually fall down much.

Anyway, there are different grades of patellar luxation. They said mine was fairly minor, grade I or II, and it was okay not to mess with it until I was having continual problems. Online research seems to indicate that it will only ever get worse. So now we had two things to worry about - an ACL tear that could occur at any time, and a luxating patella that would almost definitely one day require surgery. Fortunately, this generally wasn't a problem for the next few months. Every now and then I had to limp a little, but it was minor.

Then one weekend morning in September I was doing the Shiba 500 at full speed around the house and I went tearing down the basement stairs and boom crashed at the bottom. Daddy came to see what happened and I was standing in the basement holding my left leg up. This time it didn't magically fix itself over a day or two or three. Another trip to the vet and a few x-rays later and they said that it was most likely an ACL tear and that it would require surgery (there was brief hope that it was more minor - a small fracture in the foot or something).

This time, though, they said they didn't want to do the surgery because it was more complex - ACL tear plus a luxating patella. They said it could require two different procedures and they weren't comfortable with that. So they referred me to a specialist who couldn't see me for a while. Fortunately, they also gave me drugs (rimadyl, I think) so I could walk around reasonably well in the mean time.

The specialist looked at my x-rays, poked at my knee, and came to the following likely conclusion:

1. I had a minor ACL tear sometime months earlier, probably in early summer.
2. Fluid entering the knee due to the ACL tear was pushing the knee cap up away from the bone and slightly out of it's groove.
3. Due to it's position, it could more easily slip out of place.
4. When I was running down the steps, the knee probably slipped out, causing me to crash and the ACL to tear really badly.
5. So the ACL tear caused the knee cap issue which caused the crash which included more ACL tearing. Ouch.

Fortunately, he said the way he would handle it is that he would do the ACL surgery and any required surgery on the knee cap at the same time. He would, however, only charge for the ACL surgery. This, according to my people, was a pleasant surprise because it would cost less than expected. So a few days later I went in for my second major surgery in as many years. The procedure was much the same as the first (see earlier surgery posts) so I won't go into the details. I had different spots shaved for pain drugs and probably had the groove in my femur deepened some in case the kneecap wanted to keep slipping, but for the most part it was a similar procedure.

When I came out, I was just as miserable as last time, but just to mix things up I was also in a cast with a leg splint. This doctor said it wasn't strictly necessary, but he preferred to take the precaution. So again, after a miserable drive home crying all the way, it was time to settle in for a long recovery.

-Kobi

ACL Info

I should mention a little bit about ACL injuries. Usually, an ACL tear happens during some form of vigorous exercise, like overzealous guarding of a fence line or, in sporting dogs, during some kind of....sport. Or, sometimes, crashing down the stairs. Three other factors that may be to blame are genetics, old age, and being overweight. Larger dogs are more prone to the injury. Usually there's a brief but intense pain (if you witness it you may hear a yelp) but that should go away fairly quickly, but there's lingering discomfort and the joint will most likely not heal properly on its own without surgery. The risk and severity of arthritis is greatly increased by this injury, but the surgery should help somewhat in that regard as well.

I was only three when this happened, still a chipper young dog, and I was bred from pretty decent stock (although it's hard to know if my relatives suffered the same issue or not). I was, however, a little chubby. Most Shiba's are 18-25 pounds, and I've always been bigger than most shiba's but at the time I think I weighed 35. Compared to my now-slimmed-down weight of 28, 35 is definitely a bit too much. Now, however, I'm not chubby, just a little older (5 years old), but cursed by the vet's comment that, "If it happens on one leg, it's only a matter of time before it hits the other leg." She was right, but what she didn't predict was that I would also have a luxating patella issue in the other leg too.

That's a whole different story, though, and I've got some napping to catch up on. Until next time, enjoy the exciting pictures of a dog's knee.

-Kobi

Left: Model of the knee. Right: Diagram of the knee.

ACL Surgery The First - Part II - Recovery

So recovery started in December. Daddy was out of town, so it was just me and Mama. The backyard was covered in a sheet of ice, I had half of my hindquarters shaved, a huge sliced down one leg, I had a plastic cone around my head and I was drugged up on painkillers. Fortunately, I could still hobble around on my hurt leg, though I slipped and fell on more than one occasion.

The Rest Of The Story

This is a good time to get into another interesting fact about me...I'm extremely picky about bathrooms. I have an entire backyard of a regular suburban house to use for my bathroom. I've slotted out a couple spots up on the hill for general use, and I will not use any other spots. It doesn't matter if the hill is covered in ice and I can barely walk, I must use those spots, and those spots only. On a related note, I prefer not to use the backyard at all, and at times will refuse to do so for days at a time, waiting on a walk around the neighborhood, especially for poops. I have sphincters of steel, and I will hold it longer than any dog ever should. No one has ever explained why this is, or had any ideas on what would make me more at ease using my own backyard for a potty.

Needless to say, the first couple weeks of recovery were rough. The stitches couldn't come out for fourteen days, so even after Daddy came home life was pretty miserable. When I went out to potty with my cone on I wanted to sniff around on the ground. Since dogs sniff poo (for a variety of reason) this had the unforeseen consequence of getting poo on/in my cone, requiring frequent cleanup. Furthermore, due some or all of these factors, I decided it would be a good time to start snacking on poo. This isn't terribly uncommon in dogs, and in fact we don't even think it's that gross, but you can imagine the horror of the humans who witnessed it. A call to the vet set them at ease, though, "He'll probably stop doing that after the cone comes off." And, in fact, I did stop. Normally it would be simple to just pick up the poo to prevent me from doing this, but given the ice and snow the poos were difficult to excavate until the yard melted.

Peeing was also a challenge, I should add. For a dog used to using his right leg to prop himself up when peeing, it was a tough transition to switch to the left leg. And, in fact, I would often use the right leg anyway and just try not to fall over. This wasn't anywhere near the problem that pooping was, though.

Other problems with the cone were also very apparent. First off, I had it tied to my neck with gauss. this was soft and didn't bother me much but it made it difficult for my people to get it off and on. They came to the realization at some point that a collar could be threaded through the thing (as was probably intended) and then I could have it taken off more regularly for cleaning and general comfort. And cleaning was an issue. Not only did poo get on it, but if I ate and drank with it on, it got really gross. And, periodically, I would cough up some water or food, or on at least one occasion, throw up alittle bit. And that would get all over the inside of the thing.

In the end, though, I found some joys in wearing the cone. There is nothing more satisfying than the racket a dog can make smashing a plastic cone into walls, chairs, tables, doors, the fridge, the bed, trees, fences, etc. Want to wake up a human, smash the cone into something. "Oops, sorry, didn't mean to wake you up..." Heh heh heh.

The last major issue, after the initial drugs wore off, was keeping me calm, especially at night. During the day I was usually happy to sleep on the couch but at night I just wasn't comfortable and I cried a lot. Mama ended up sleeping on the floor with me a couple of nights, and then for the next couple of weeks Daddy did the same. They dragged a mattress out of a fold-out couch and put it in the bedroom so I could sleep on it with them. Although I still whimpered and wined sometimes, I was much happier (and warmer) with this arrangement. I don't think Daddy slept especially well, though.

And, of course, once my stitches were out, I still wasn't able to move around very well for a few more weeks and it was always a battle to keep me calm. Before long I was jumping on the couch, chasing squirrels, and trying bound around regardless of the limping that would surely follow. Although I was moving around pretty well after just a month or so, it would be another 4-5 months until the limping went away for good even after a few full-speed laps around the yard or a long walk. The important thing is that the limping did finally go away, and by the following October I was capable of a 3-day backpacking trip again.

-Kobi

Left: Limping around after the ice melted. Right: Looking chagrined in his cone.

ACL Surgery The First - Part I - Surgery

On Thanksgiving of 2006 I was outside with my people at a relative's house. I was bravely doing my rounds in the backyard when a neighbor Akita puppy came charging right at me. I ran up and down the fence barking furiously and somehow I twisted my knee wrong. It might possibly have been because I was running over a pile of old firewood on a hill trying to attack another dog four times my size through a chainlink fence, but we'll never know the exact cause. [Editor's note: the Akita puppy was the single most playful dog I've ever seen and was only being friendly. Kobi didn't appreciate the attention, though.]

The Rest Of The Story

I probably yelped pretty loudly when I twisted my knee but due to all the comotion no one heard me if I did some noise and I was too busy to care. But after I calmed down and went back inside I started limping. I could barely move around for the rest of the evening. The next day I was feeling a little better, but could barely put any weight on my back right leg. I was not a happy dog.

When we got back home my people called the vet and I had to go up for x-rays. On the x-ray it was clear I had no broken bones, and with some poking they determined that I'd torn my ACL. There are several options for a dog with a torn ACL. Depending on how bad it is and the activity level and size of the patient they might recommend different things. The two options I had were as follows:
1. Have surgery done by my regular doctor that involves cutting out the bad bits of ACL and basically, using a synthetic line similar to fishing line, rebuilding the ligament by threading the line through/around my leg bones.
2. Go to a specialist to get surgery that involves bone adjustments. I think there was some filing down of one of the leg bones to facilitate some realignment that would, in turn, negate the need for the ACL.

I don't remember the specifics of option two because we went with option one. Here's how major dog surgery goes down.

• The vet did some blood tests to make sure various levels of this and that were appropriate in my blood and the anesthesia wouldn't kill me or anything.
  
• My people stopped feeding me the night before the surgery. No breakfast the next morning even though I was hungry.
• They dropped me off at the vet in the morning of the surgery. I would have the operation, spend the night, and go home the next day.
• The vet put me under, shaved my entire right leg all the way up practically to my tail. My skin, it turns out, is a pinky/purpley color.
• She sliced my knee open, all the way down to the bones and did the thing with the fishing line.
  
• She sewed me up, sewed a morphine patch to a little spot shaved on my back, loaded me full of painkillers, and watched me for the next 18 hours or so to make sure I was okay.
• She put an E-collar on me (that's the satellite dish thing that kept me from licking my wounds) and sent me home.

The drive home was miserable and I cried the whole way, but once I got home Mama put me on the couch with a blanket over me and I started what would be a fairly lengthy recovery.

More on recovery later, now it's time for a nap.

-Kobi

Left: Recovering on the couch. Right: At home, right after surgery.

Introduction

The dogs asked me to set this up for them, they wanted a place to tell Fred and Valentine and Frannie and any other dogs that are interested about some of the stuff they do. They have unique perspectives - Kobi has had a couple of surgeries, Milo is a rescue dog who escaped into the "wild" for three days, etc. etc.

I think Kobi is going to start out talking about ACL surgery because he's laid up in recovery right now and needs something to do. Milo will backtrack to some of his stories later on. I'll be helping them out, they have a hard time typing and I have access to the camera and pictures, but I'll try to keep the stories from their perspective with maybe a few details from the humans involved. I hope their stories are helpful for other dog owners out there.

Enjoy!
-Byron (aka "Daddy")
Caretake and Provider for Kobi & Milo

Left: Byron and Kobi. Right: Byron and Milo.