Is this typical bilateral OCD Surgical Recovery? - Page 1

Good Morning All,

Yesterday morning my little girl went to squat to pee and immediately cried out in pain and would not put the left leg down. See thread http://www.pedigreedatabase.com/community.read?post=900173-ocd-5-mo-puppy-preop-xrayspostop-care for what I have been doing to care for her.

Anyway, she would not stop crying and would not put the leg down and I could not get her calmed down. Since I’ve had her she has NOT been the typical “vocal” GSD that I know this breed can be. She is not what I would call a “dramatic” pup. She has been VERY stoic throughout this entire process.

So I ran her to the vet, the ortho who did the surgery was not in. Another vet who HAS been a part of her care evaluated her. We had xrays of both stifles and nothing showed up as any kind of fracture, change, shifting etc. There WAS a significant amount of soft tissue swelling at the suture line on the RIGHT leg just around the knee but NOTHING showed in either joint. They gave her IV Toradol for pain and to calm her down also so as to be able to do the radiographs. When they examined the left leg there was no impingement, loss of ROM, no palpable swelling, good bilateral femoral pulses, no swelling in either ankle, capillary refill in both legs near saphenous vein were good. If she should be in pain from anything it should be from the small amount of excess swelling on the RIGHT leg near the suture line. But she is not. That is not tender at all. She WAS extremely tender to palpation on the left knee near the suture line. But to reiterate - ALL range of motion in that leg are normal and all radiographs are normal. So they added Gabapentin 200mg, qid x 8 hours on top of the Trazodone 200mg qid, x 8 hours and the Rimadyl bid x 12 hours and all medication to be staggered so that she’s not ever completely coming off of any of the pain/chill medications. The Toradol seemed to have stayed with her for a while and per the vet I loaded her up with the Gabapentin as soon as I got her home so that it would be on board and working when the Toradol wore off.

OMG last night was a nightmare. As long as she was still and sleeping - great. If she only moved a bit - great. The minute she moved too much or I took her out to pee and poo - not so good. She’s crying and in a LOT of pain on that left leg. And THAT was the leg I originally noticed the lameness in. The ortho specialist is back in the hospital today. I just dropped her off. He is going to examine her between surgical cases to make sure nothing has happened. He’s don’t hundreds of these surgeries and is an expert on the recovery process.

Here’s the questions:
1. Has anyone ever had these experiences before with recovery? i.e. is this “normal?” for one week post op?
2. Other than what I am doing and have been doing, in addition to the nutritional supplements, ices packs etc. does anyone have any suggestions?

Thanks

If was my dog, I would stop all the drugging. Also, the fentanel patches sounded pretty dangerous, since a speck of fentanel on skin has caused life threatening/death to LE inadvertantly contaminated by it.
My suspicion is that a nerve is being screwed up by scar tissue, being that this problem has occurred such a long time after surgery.
Also, my veterinarian is very conservative, and would likely not have done the surgery...didn't you say doing the surgery or not doing can result the same.

Feel very sorry for you poor girl.

Poor, poor dog. I agree with Joan's suspicion, however, I wonder if she could still have pano. For all we know, that was why she was lame in the first place and surgery won't fix pano. Pano doesn't always (often) show on x-rays until it's been going on a looonnng time, and you decided on surgery so fast it's likely it wouldn't show in the pre or post-surgical films. So often, on films, you can find things that "might" be a problem if you're looking for problems, but unfortunately they aren't really the cause of the lameness and the surgery to address them doesn't fix the acute problem. Worst part is, it's hard to tell. As an example, I've seen normal hips xrayed in poor position on a 6month old dog suspected by her breeder and I to have pano, but the vet and owner decided on surgery for HD. The puppy was a loosely-ligamented pet not in the best physical condition (over-fed, under-exercised, lived in apartment) and had some MINOR subluxation but no damage to the femoral heads. Well, guess what? A year later her owner says she's doing great now and is so happy she had the surgery on her hips. Well, she'd have been doing great regardless, surgery or not, because her pano was the problem, not her hips, but you can't prove that after the fact, so my approach with any pup that young is conservative.

All that is water under the bridge now, but I wanted to point out another scenario why your dog could still seem worse after surgery than she was going in. I have seen dogs w/pano undergo other procedures and get very painful- as it's an inflammatory condition, I wonder if it is a bit reactive to stress on the body. Haven't one iota if scientific evidence to support that, but I've seen dogs limping along w/mild pano become so painful they could hardly move after vaccinations, baby tooth extraction, etc. Just suspect a stress/inflammatory response in that over pure coincidence.

Hope that poor girl is better in no time.

Yep, pano can cause severe pain and reluctance to use affected leg. I've seen gsd with pano in all four legs, unable to walk at all.
What bothered me by your vet's hurry to do surgery on both stifle joints in such a young dog, is that the growth plates probly have not yet closed. I could be wrong ,but I don't think I am. In which case, this poor dog is screwed.

Update on my little one:

She’s staying at the vet through Saturday morning so they can manage her pain. And I can’t help but feel like I’m abandoning her but I also am glad because I can get some sleep and work done.

Joanro & Jenni78: As far as any rush, since this is my first time I’ve no idea if it was a “rush” for surgery or not. I’m not justifying or accepting anything with regards to the decision so please do not hear me in such a way as to think either of your comments are bad or negative or insulting. Certainly this is not the case. What I CAN I can say is I made the best decision with the information I had.

I know I took her to four different specialists over three weeks, paid out an additional 2000.00+ in radiographs and testings, tried water PT, and worked with her diet. The arthroscopic pictures from the surgery do show where there were lesions bilaterally. There were no “floaters,” or “shelf mice” but there were distinct “flaps” on the lateral femoral condyles of both stifles. On the left it was about the size of a nickel. On the right it was a little smaller than a dime. The two different specialists who read her radiographs, along with the Orthopedic specialist and her normal vet all saw what they termed as “significant flattening" of both condyles, the left being worse than the right. I put in their readings and diagnosis somewhere back there in the other thread. The research I read did indicate that surgical intervention of OCD of the stifle has not always proven effective. However both research, and the specialist all concluded separately that acute sudden onset of lameness with significant changes, if not treated soon enough, and in most cases, only the floor of the defect fills with fibrocartilage and severe secondary osteoarthrosis develops rapidly.

Honestly? IDK. I really don’t. IDK if surgery was the right choice. IDK if NOT having surgery would have been the right choice. Several, independent specialist, read her radiographs and three examined her. One of whom read her very last set of radiographs prior to me choosing to have the procedure done was from UTK.

I’ll ask about the Pano when I go in tomorrow morning to see her. When the ortho called me this afternoon he did say that with Gabapentin she seems to be doing much better and is walking now on both again. Since Gabapentin is a type of nerve pain med (a type of which is used for diabetic nerve pain in humans) I’m leaning towards the idea that it might be pano. All I know is I’m more than a little concerned, tired, and very irritated at myself for not listening to my gut and running the other way when I was at the Breeder’s Kennel. I do not begrudge caring for this little one. Not at all. But it does sicken me that my fee will go to continue this cycle for a bit longer. Live and learn I guess.

She stayed at the vet last night. They kept her there to monitor her pain levels. They finally got them under control. She is walking now on both legs again, pee/poo, resting, and enjoying their therapy massages of her spine and back end. The ortho believes the restriction of movement was from the pain of the suture line. He and the PT therapy person can move both legs, flex them, work with her without any issue. And she has yet to snap, growl, bite, nip or in any way respond in a negative way to the pain she is experiencing. Soooo....it appears about the only thing this Breeder DID get right was her temperament. And I’m not sure the Breeder can really claim responsibility for that! I think its just she’s a special girl AND, I’d like to think, my work with her and care for her has allowed her to bond with me so she trusts me even though she is hurting right now.

I’ll pick her up tomorrow morning between 8-9AM. She’ll stay with me for the weekend and then I’ll take her back in at 7AM Tuesday before I leave town. He’ll take her stitches out then and do another set of radiographs. Presuming all is still well she starts hydrotherapy that day and will have it every other day until I move. On the off days she has acupuncture treatments. For now I think this is the best I can hope for.

Update: Well, my little one is NOT coming home tomorrow. She will be staying the weekend at the hospital where they can continue to monitor her for both pain and ACTIVITY.

 

Apparently she began to feel quite lively again and was doing very well. She was happy, bright, walking well and moving well on both legs equally, squatting to pee/poo with no issue etc.... In fact, she was doing so well that she became restless and curious...and managed to figure out how to unlock her LOCKED cage/Crate door!

 

Toward that end she got out and began to promptly run around and both attempt to play with, and tease, the other poor patients who were also so “incarcerated.” The resulting activity was not damaging in any way, according to the ortho. She was not jumping, nor did she jump down to get out as her crate/cage was on the bottom. However, she did “run around a bit excitedly," more so than he was comfortable with, so he would like to keep her there until Monday to make absolutely sure she has not done too much that would increase her pain levels again. All swelling HAD gone down, however she’s got a bit more again now and is a bit tender. Obviously I am not being charged for any of this. And they actually offered to keep her two nights for me so that I could get some sleep initially when all this started....which I SOOOO appreciated.

 

(Sigh....) I don’t know whether to laugh at her intelligence and subsequent mischief or be mad as hell at both her and the staff who were supposed to watch her! Guess it goes to show her intelligence level. Presuming she shows no ill effect from running up and down along side the bottom cages “sticking her tongue out at everyone teasing them” as the ortho stated, then on Monday the sutures will be removed and she’ll start PT a day earlier than anticipated. Of course, I should have known. All one has to do is just look at this face and tell she’s not going to be satisfied with just “status quo.”

 

(OMG she is so stinking cute!)

So very sorry to hear all this.
I would be a bit careful in keeping her in a strange place too long, especially a clinic. Keep her with you if you can. She is at an age now, and for the next 5-6 months, where they can get spooked at strange things or start obsessing over things easily... Call it a fear or a caution phase, or whatever, even if they have been very stable emotionally up to now. Once they spook at something, you will have your hands full with the fear or compulsion about something, perhaps for the rest of her life.
She may have had a synovial impingement episode when she started screaming, perhaps because of the swelling of tissues in the joint, as that really hurts like heck.
It can happen easily if the knee is twisted just a certain way, and would fit as her quads are probably weak on the left leg due to the lameness lately. The weak quads will make for an unstable knee joint, along with instability due to surgery as well. Once the synovial fold is no longer impinged, the pain can dissipate. Sounds like she is good now.
But, why would vet not charge for weekend kennel costs, unless they feel guilty about something? A 5 mo old teething pup can not get out of a cage unless it was not closed correctly in the first place. Don’t sound right to me. She should not be running around the clinic. Also, she is still a pup and you don’t really want her around germs, bacteria or virus, or ill animals as are in clinics. I would not trust anyone with my pup, not even a clinic. Especially not a clinic with workers that I don;t know...that may or may not be trustworthy. I mean no offense towards good vets or vet assistants, but there are those that don’t know what they are doing.
She is awfully cute. I wish her all the best.

Jessjones: Honestly I thought that exact same thing myself. And I do plan to go back in and see her this morning as soon as they open. If she’s moving around well and in good spirits I think I’ll bring her home. Yes I know I’m taking a chance but.....I just don’t know. And she HAS to be there next week while I travel for three days.

Update: My little girl had to have surgery again Monday. He went to take her staples out. He gave her a sedative so as to take radiographs and not have her in pain and also to exam/manipulate the joint to be sure everything was still fine. AAAAAAAAAND, the left knee cap was lose. I’m not going to say I “swear” by this ortho but I WILL say he’s DAMN good. His ortho residency a top vet ortho residency in here in the states. Apparently last week when she went to pee and screamed and I could not get her pain under control the facia securing the knee cap back in place had torn where he had put the joint back together. OCD develops as early as 4 months in extreme cases. According to some research, which I’ve been given the references to read, if it DOES show up so suddenly, and so early, AND its bilateral, particularly in the stifle, which has such a huge issue because it is a large weight bearing joint, the pup will actually begin compensating before lameness begins. In doing so muscle and facia tissue surrounding the stifle joint atrophy and weaken. Her radiographs showed “severe atrophy” on the left side. All of this made for a nasty combination of factors that lead to the internal sutures he used, the same as he did on the right knee, did not hold. Sooooooo, he had to scope her again yesterday morning, repair everything, get everything fixed back up, stitch her back up, and now she’s recovering AGAIN. He said this has happened very times out of a “couple hundred surgical cases" Of course it’d have to be MY dog! :-(

I did tell him that under no circumstances could I or would I do surgery on her again. Its not fair to her first, and I just really can’t handle it. Nor can I afford it. He completely agreed. He also is not charging me for this one nor for the hospitalization boarding since last week. He recommends she stay there in the hospital the next 10-12 days under 24 hour watch and supervision to manage her pain and basically keep her as drugged as possible to keep her as still as possible to let everything heal. He did say the area where he removed the lesion has begun to fill in and heal fine and the later femoral condyle is getting “much better blood supply and should heal all the way.” He thinks, and the other specialists do also, that if her temperament stays the same, and I do all the rehab correctly with her, the best thing for her actually may well be for her to be my hearing SD because: 1. its not an overly active demanding job for her, 2. she will be well cared for, 3. she will be active enough with my hiking, jogging, kayaking etc. to stay healthy and lean, 4. and he knows from his experiences with all my other dogs that I will make damn sure she gets the best food and care I can provide.

I spent some time with her this afternoon. She is still so very sweet and its obvious she’s “MY” girl. I sat there with her and did some TTouch to help her relax and also on her spine, and haunches. She didn’t go to sleep but she relaxed quite a bit. They are researching providers for me to use up north. She’s such a sweet, beautiful little girl. (Well....maybe not so “little” any more!)