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Thinking of you and Perry during his recovery and hoping the xray results do not detect any further issues.
Perry's twisted leg surgery
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We were assuming that he wouldn't get any more range of motion in it, which was fine, the concern right now is that he seems to have lost some range, so will see what the xray shows next week.
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We had Perry's check up yesterday - and can I say how much I really like his vet/ clinic. She came out to the parking lot and talked to me for as long as I needed, no impatience or anything. In addition, while a few xrays were covered in the surgery costs - for yesterday's visit the xray AND a laser treatment - they didn't charge us for them.
So, an update. The good news - the pin hasn't moved and the plate still looks good, not impinging on the wrist at all. Of course, that's also part of the bad news because it means that it's not a simple reason why he's lost range of motion. She's seeing arthritis, but no big increase that would account for losing range of motion. She did a laser treatment on it to see if that would help and will be consulting with his PT vet on what we might want to try going forward. She did say that he's improved dramatically from a month ago, in terms of usage, but that he's "at 6 months where we would have wanted him to be at 6 weeks". She is getting about a 60 degree bend on it - it seems to vary because his PT vet one week was seeing no bend, the week before about 50-60 degrees... but all down from the 90 we had after surgery. She did say that it wasn't a major problem though - that it is flexing up properly and that's what's most important for walking/ stability and they can be perfectly fine without any back flex (like, for example, when they fuse ankle bones) - but that the concerning part was that it's gone backwards with no readily discernable reason. There really was no change from his xrays a month ago.
Because she's wondering if it's the arthritis bothering him, we discussed it and decided to put him on Adequan to see if that helps. It's an arthritis med that is an injection (oh joy, I get to inject him sub-cutaneous) that he will get twice a week for a month, then once a week for a month and then every other week. We will see if that makes any difference. Luckily it doesn't have to be refrigerated so we can take it with us when we travel (hopefully there are no specific country prohibitions). We're also keeping him on the gabapentin for the moment as well as the joint supplement and fish oil.
She also mentioned a few other treatments we can try - so was wondering if anyone had any experience with them. There are three other options - aimed at arthritis - (1)hypobaric (2)shockwaves and (3)stem cells. She said that they could do 1 and 2 at the same time or 1 and 3, but won't do 2 and 3 (said there's not enough research on doing them together and there's a fear that the shockwaves will break up the stem cells too much). She said basically it was something that would be done daily over a week and if it worked, that would be it (I presume for a while - maybe when he was older he might need it again?)
She said that I could either bring him daily OR if I needed to go out of town, for example, I could leave him there and they could do the treatments over the week (as a side note, her eyes lit up when she said that because she said the techs - aka his girlfriends - like it when a pup is there like that because when they're between exams they go and take them out and love on them
- they become the office dog for the week - I'm sure Perry would love that since, when the nurse brought him back out to me, there was no scrambling to reach Mom, he was perfectly happy snuggled in her arms).
So, question - has anyone done any of those treatments and what did you think/ how did they go? I'm going to do some research as well, but interested in your experiences.
So, an update. The good news - the pin hasn't moved and the plate still looks good, not impinging on the wrist at all. Of course, that's also part of the bad news because it means that it's not a simple reason why he's lost range of motion. She's seeing arthritis, but no big increase that would account for losing range of motion. She did a laser treatment on it to see if that would help and will be consulting with his PT vet on what we might want to try going forward. She did say that he's improved dramatically from a month ago, in terms of usage, but that he's "at 6 months where we would have wanted him to be at 6 weeks". She is getting about a 60 degree bend on it - it seems to vary because his PT vet one week was seeing no bend, the week before about 50-60 degrees... but all down from the 90 we had after surgery. She did say that it wasn't a major problem though - that it is flexing up properly and that's what's most important for walking/ stability and they can be perfectly fine without any back flex (like, for example, when they fuse ankle bones) - but that the concerning part was that it's gone backwards with no readily discernable reason. There really was no change from his xrays a month ago.
Because she's wondering if it's the arthritis bothering him, we discussed it and decided to put him on Adequan to see if that helps. It's an arthritis med that is an injection (oh joy, I get to inject him sub-cutaneous) that he will get twice a week for a month, then once a week for a month and then every other week. We will see if that makes any difference. Luckily it doesn't have to be refrigerated so we can take it with us when we travel (hopefully there are no specific country prohibitions). We're also keeping him on the gabapentin for the moment as well as the joint supplement and fish oil.
She also mentioned a few other treatments we can try - so was wondering if anyone had any experience with them. There are three other options - aimed at arthritis - (1)hypobaric (2)shockwaves and (3)stem cells. She said that they could do 1 and 2 at the same time or 1 and 3, but won't do 2 and 3 (said there's not enough research on doing them together and there's a fear that the shockwaves will break up the stem cells too much). She said basically it was something that would be done daily over a week and if it worked, that would be it (I presume for a while - maybe when he was older he might need it again?)
She said that I could either bring him daily OR if I needed to go out of town, for example, I could leave him there and they could do the treatments over the week (as a side note, her eyes lit up when she said that because she said the techs - aka his girlfriends - like it when a pup is there like that because when they're between exams they go and take them out and love on them
- they become the office dog for the week - I'm sure Perry would love that since, when the nurse brought him back out to me, there was no scrambling to reach Mom, he was perfectly happy snuggled in her arms).So, question - has anyone done any of those treatments and what did you think/ how did they go? I'm going to do some research as well, but interested in your experiences.
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It's been a while since we gave an update... mostly because things have basically stalled. We've been doing PT, accupuncture and cold laser for a few months now with little change - and, in fact, some weeks it feels like we're regressing with him not using his leg as much.
He had his yearly xray visit to his ortho - to recheck the lesions on his spine (no change which is what we want) and an ultrasound of his bladder - to check the nodule they saw the last time. They think there was "minimal" change in size of that - but they want to do a urine test to check for cancer anyway (haven't done it yet... trying to schedule it for March, maybe). His liver enzymes are still high - so the vet put him on a few more supplements (orsodiol, zinc, vitamin E) and wants a recheck blood test in March... and said that he would want to do a biopsy if they were still high. Not sure about that - I thought there was a urine test that could be done first, but still checking on that. In the meantime, that puts Perry up to 8 meds and supplements (cosequin and wellactin / joint supplements. Denamarin, orsodiol, zinc, vitamin E for the liver enzyme levels, adequan for arthritis - though not sure that's actually helping, and gabapentin because thery thought some of the leg issues might be nerve pain, but also not sure that's helping).
As for the leg... it seemed to be improving a bit from the cold laser, but then stalled. I haven't noticed any difference from the accupuncture, but continued it just in case. the last couple of weeks though it feels like he's gone backwards, using the leg less/ hopping around on 3 legs more - though still using the leg most of the time.
All of the vets (ortho, PT, accupuncture) are completely stumped as to what it might be. As I mentioned in the last update, his ortho vet had mentioned a few treatments we could try (hypobaric, stem cell, shockwave) - but it's feeling like we're throwing stuff at it, not sure what's actually wrong (we are doing the gabapentin because it might be nerve pain and that did seem to help somewhat... the adequan is for arthritis even though none of the vets think the arthritis looks that bad yet though it is there and that didn't seem to help. We added acupuncture because that seems to help some dogs with mobility issues, but I haven't really seen any improvement with that. The cold laser was to see if it could improve things, and he had seemed to have gone backwards for a few weeks and that took us back to what I was referring to as the baseline of where we were in December and water therapy had originally gotten us past a point where he was maybe using the leg 50% of the time to using it about 80+% - but nothing has gotten us to consistent use of the leg).
So, on the advice of his PT vet, we've made an appointment with VOSM (Veterinary Orthopedic and Sports Medicine) outside of Baltimore. They're meant to be the top (one of the top) animal sports medicine clinics in the country / world and have people coming from all over to see them. His PT vet says that's the place she goes with her dogs (she has a couple of search and rescue dogs.) She says that they have every kind of diagnostic equipment known to man and can get to the bottom of what the problem actually is. At this point, that's all I want to know - rather than just adding more meds, or continuing ones that might not be needed/ might not do anything or trying more treatments that may or may not work (and not knowing which did it or why), I want them to figure out what the problem is, what can be done (or not) and pare down treatment to what's actually necessary.
We have an appointment with the head guy - Dr. Canapp, who the PT vet recommended we see. It was funny because when they finally called us to make the appointment (for new patients, you go and put all the info into an online form, have his records sent, they review and then they call you to make an appointment), they were giving us an appointment with another vet for March 4th. I mentioned that our PT vet had recommended we see Dr. Canapp directly (because of how perplexing this whole thing has been for all of them), and they said that he didn't have an appointment til April, so I said that was fine, we could see the other vet, and worst case if needed we could make a follow up appointment with Dr. Canapp. At that point, they found a free spot with Dr. Canapp on March 7th. So, that's our current plan.
I'll pick hubby up at the airport on the 5th (he's returning from Ethiopia), do something fun on the 6th, and spend the day at VOSM on the 7th. They did reserve a slot on the 8th for surgery if that turns out to be what's needed (I really hope not, but nice of them to do that just in case). I had to take video of what he does - so I have some videos of him hopping around, some of the hop-skip movement that he does, and some of him sitting there and repositioning the foot, though that one is harder to catch. Then they'll hopefully throw as much of the diagnostics as they have at him... they have an ultrasound scheduled for sure, so I assume they'll be ultrasounding the muscles to see if that could be the problem. I've been told they have things that measure their gait and the pressure they put to see if they're putting their whole weight on it (I know he doesn't always - when he's sitting on me it is obvious sometimes that he's not putting as much weight on that leg as on the other).
Thank goodness for insurance. We could afford all of this without the insurance, but it's still nice not to have to. This year alone (i.e. Jan 1 - Feb 14) we're at almost $1900 in bills and $1700 in reimbursements and I imagine that the VOSM bill is going to be a crazy amount .
He had his yearly xray visit to his ortho - to recheck the lesions on his spine (no change which is what we want) and an ultrasound of his bladder - to check the nodule they saw the last time. They think there was "minimal" change in size of that - but they want to do a urine test to check for cancer anyway (haven't done it yet... trying to schedule it for March, maybe). His liver enzymes are still high - so the vet put him on a few more supplements (orsodiol, zinc, vitamin E) and wants a recheck blood test in March... and said that he would want to do a biopsy if they were still high. Not sure about that - I thought there was a urine test that could be done first, but still checking on that. In the meantime, that puts Perry up to 8 meds and supplements (cosequin and wellactin / joint supplements. Denamarin, orsodiol, zinc, vitamin E for the liver enzyme levels, adequan for arthritis - though not sure that's actually helping, and gabapentin because thery thought some of the leg issues might be nerve pain, but also not sure that's helping).
As for the leg... it seemed to be improving a bit from the cold laser, but then stalled. I haven't noticed any difference from the accupuncture, but continued it just in case. the last couple of weeks though it feels like he's gone backwards, using the leg less/ hopping around on 3 legs more - though still using the leg most of the time.
All of the vets (ortho, PT, accupuncture) are completely stumped as to what it might be. As I mentioned in the last update, his ortho vet had mentioned a few treatments we could try (hypobaric, stem cell, shockwave) - but it's feeling like we're throwing stuff at it, not sure what's actually wrong (we are doing the gabapentin because it might be nerve pain and that did seem to help somewhat... the adequan is for arthritis even though none of the vets think the arthritis looks that bad yet though it is there and that didn't seem to help. We added acupuncture because that seems to help some dogs with mobility issues, but I haven't really seen any improvement with that. The cold laser was to see if it could improve things, and he had seemed to have gone backwards for a few weeks and that took us back to what I was referring to as the baseline of where we were in December and water therapy had originally gotten us past a point where he was maybe using the leg 50% of the time to using it about 80+% - but nothing has gotten us to consistent use of the leg).
So, on the advice of his PT vet, we've made an appointment with VOSM (Veterinary Orthopedic and Sports Medicine) outside of Baltimore. They're meant to be the top (one of the top) animal sports medicine clinics in the country / world and have people coming from all over to see them. His PT vet says that's the place she goes with her dogs (she has a couple of search and rescue dogs.) She says that they have every kind of diagnostic equipment known to man and can get to the bottom of what the problem actually is. At this point, that's all I want to know - rather than just adding more meds, or continuing ones that might not be needed/ might not do anything or trying more treatments that may or may not work (and not knowing which did it or why), I want them to figure out what the problem is, what can be done (or not) and pare down treatment to what's actually necessary.
We have an appointment with the head guy - Dr. Canapp, who the PT vet recommended we see. It was funny because when they finally called us to make the appointment (for new patients, you go and put all the info into an online form, have his records sent, they review and then they call you to make an appointment), they were giving us an appointment with another vet for March 4th. I mentioned that our PT vet had recommended we see Dr. Canapp directly (because of how perplexing this whole thing has been for all of them), and they said that he didn't have an appointment til April, so I said that was fine, we could see the other vet, and worst case if needed we could make a follow up appointment with Dr. Canapp. At that point, they found a free spot with Dr. Canapp on March 7th
. So, that's our current plan. I'll pick hubby up at the airport on the 5th (he's returning from Ethiopia), do something fun on the 6th, and spend the day at VOSM on the 7th. They did reserve a slot on the 8th for surgery if that turns out to be what's needed (I really hope not, but nice of them to do that just in case). I had to take video of what he does - so I have some videos of him hopping around, some of the hop-skip movement that he does, and some of him sitting there and repositioning the foot, though that one is harder to catch. Then they'll hopefully throw as much of the diagnostics as they have at him... they have an ultrasound scheduled for sure, so I assume they'll be ultrasounding the muscles to see if that could be the problem. I've been told they have things that measure their gait and the pressure they put to see if they're putting their whole weight on it (I know he doesn't always - when he's sitting on me it is obvious sometimes that he's not putting as much weight on that leg as on the other).
Thank goodness for insurance. We could afford all of this without the insurance, but it's still nice not to have to
. This year alone (i.e. Jan 1 - Feb 14) we're at almost $1900 in bills and $1700 in reimbursements and I imagine that the VOSM bill is going to be a crazy amount .
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Thanks Karen. What are your thoughts about VOSM? Did you consider going there with Kodi/ know people who have?
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I didn't even know about it until you mentioned it. OTOH, we do have Tufts nearby, and they have a lot of the same available. However, in Kodi's case, we KNEW it was soft tissue, and we KNEW it was his shoulder. So it wasn't quite the same situation. Shoulders are such a funny thing in a dog, because the shoulder blade is not attached with any bone to the rest of the skeleton. There really WAS no chance of a surgical fix. The only "ultimate" option, if he had remained SO painful that we could not have gotten him comfortable any other way would have been to amputate that leg. (at which point, my very good sports medicine vet and I had already discussed that he would be referred to an orthopedist at Tufts) And FORTUNATELY, we never to that point. We were able to control his pain with meds while we VERY SLOWLY and carefully worked him through the rehab process.
The biggest problem was that, being a dog and not understanding, the minute he felt better, he'd do something to hurt himself again...
Hi Melissa, I noted you haven't been around too much recently, so it is good to get this update. You do have a lot on your plate right now!
I cannot offer anything with regards to Perry's issue other than wish you and Perry well. The only advice I can offer from my personal experiences is to be patient but persistent while remaining optimistic in achieving your goals. Your update appears that you are doing that with regards to Perry. So keep us posted on your progress with a good resolution to Perry's ailments. All of us on HF are here to give you moral support if nothing else.
I cannot offer anything with regards to Perry's issue other than wish you and Perry well. The only advice I can offer from my personal experiences is to be patient but persistent while remaining optimistic in achieving your goals. Your update appears that you are doing that with regards to Perry. So keep us posted on your progress with a good resolution to Perry's ailments. All of us on HF are here to give you moral support if nothing else.
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I didn't know about it either - I had only ever really heard about Cornell (NY) here - but the PT vet said VOSM is the top and to go there, so that's where we're going
. The good news is that it doesn't really slow him down. He's still running and doing zoomies and jumping all over the place (and fingers crossed we never have to consider restricting that long term - because then it becomes a decision between current quality of life versus longevity). So we will see what they say and go from there. As long as he's not in pain, I'm ok if he continues to limp and sometimes not use it, I just want answers as to why and what we can expect/ the best we can get from the right treatment.
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I can handle the steps forward and steps back if (1)we were sure what we were doing was actually addressing the problem and (2)there were still some steps forward, instead of feeling like we weren't making any forward progress at all right now and were just regressing again. So fingers crossed that the next visit will give us some answers. Glad it's only in a couple of weeks, I'd been told it can sometimes take months to get an appointment with them.
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Melissa, you're an awesome Mom, Perry sure is a lucky boy. Sending positive vibes and hugs to you and your sweet Perry. 💓🙏
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Yes, it's not the same situation. Kodi was clearly in pain. He would shake with pain and cry.I didn't know about it either - I had only ever really heard about Cornell (NY) here - but the PT vet said VOSM is the top and to go there, so that's where we're going
The good news is that it doesn't really slow him down. He's still running and doing zoomies and jumping all over the place (and fingers crossed we never have to consider restricting that long term - because then it becomes a decision between current quality of life versus longevity). So we will see what they say and go from there. As long as he's not in pain, I'm ok if he continues to limp and sometimes not use it, I just want answers as to why and what we can expect/ the best we can get from the right treatment.
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This one needs a "hug" emoticon
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Sending hugs and kisses from Molly and I for Perry's continued recovery and hoping for some answers to your questions. 💕
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It was very sad at the time, but fortunately, he's doing really well now, although he'll never be a competition dog again!
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I realized I hadn't updated here in a while so thought I'd post a new one. We're heading out on a 2 month trip to Kenya next weekend so we've been getting all sorts of vet stuff sorted out before that.
In the last couple of months we still haven't figured out the problem totally, but Dr. Canapp (VOSM) and Perry's regular ortho vet seem to be in agreement that the most likely problem is that there's too much metal in his leg and it's causing him discomfort and that the best course of action is to try to remove the screws and plate from his leg. We had a CT scan done in March which seemed to indicate that the bone under the plate was what they call a "partial non-union" - it hasn't healed fully/ solidly. So before we can consider pulling any screws which will make the bone even less stable we need to try to get it built up. The CT scan also cannot rule out osteomyelitis or a bone infection causing the bone to not completely heal properly. The treatment plan has been (1)shockwave treatment on 2 places in the leg (and the elbow to try to break up some of the arthritis) (2)ultrasound on those places as well (we were recommended to get a portable ultrasound machine called an exogen which is used on people for bone healing - you can get them online from people who were prescribed them for their own bone healing - they are good for a certain number of treatments so cheaper than new) - we were really happy that Healthy Paws actually covered the cost of the machine and (3)an antibiotic for a few months to deal with the potential infection.
He's had 2 shockwaves and has his third next week. We got the exogen a week ago so have been doing that every day - 20 minutes on each spot - and Perry has been so incredibly patient lying there for 40 minutes so quietly while I hold the ultrasound on his leg.
The vet is going to do a new xray Tuesday to see if we have had any change... and then the plan is to continue the exogen and antibiotics while we're in Kenya and then get a new xray or CT scan when we're back in July to see if we're ready to remove any screws. Then we will do a couple of screws at a time - having to let them heal in between so I assume that means continuing the exogen, possibly packing the area with stem cells or bone marrow to help healing and then considering if we remove the other screws and the plate or not.
I am worried that he's still got pain or something in the foot... he actually was nipping at his groomer on Thursday when she was trying to cut his nails and he's never done that before. I'm going to bring that up to the vet on Tuesday.
Between the leg and his raised liver enzyme levels he's on waaaaay too many meds and supplements.
Leg:
Adequan shots twice a month
Cosequin (joint supplement)
Welactin (fish oil supplement)
Cephalexen (antibiotic)
Gabapentin (for nerve pain)
Liver:
Denamarin
Ursodiol
Zinc
Vitamin E
I also added a probiotic back since he's on an antibiotic and the occasional trazadone to help with anxiety/ when he needs to stay calm for vet procedures, etc.
He doesn't mind being on so many things because it means more peanut butter for him.
Right now we're getting ready to go to Kenya - which means a USAD endorsed health certificate. Our regular vet is so great because you now have to do the health certificates online (which she never did before but she's doing for me) and then, "because of COVID" (in reality I think it just makes their life easier not having to deal with people) USDA is not accepting in person appointments to get the endorsement so it has to be FEDEX/ UPS overnight back to me - so stressing a little about getting it back in time/ before we travel.
In the last couple of months we still haven't figured out the problem totally, but Dr. Canapp (VOSM) and Perry's regular ortho vet seem to be in agreement that the most likely problem is that there's too much metal in his leg and it's causing him discomfort and that the best course of action is to try to remove the screws and plate from his leg. We had a CT scan done in March which seemed to indicate that the bone under the plate was what they call a "partial non-union" - it hasn't healed fully/ solidly. So before we can consider pulling any screws which will make the bone even less stable we need to try to get it built up. The CT scan also cannot rule out osteomyelitis or a bone infection causing the bone to not completely heal properly. The treatment plan has been (1)shockwave treatment on 2 places in the leg (and the elbow to try to break up some of the arthritis) (2)ultrasound on those places as well (we were recommended to get a portable ultrasound machine called an exogen which is used on people for bone healing - you can get them online from people who were prescribed them for their own bone healing - they are good for a certain number of treatments so cheaper than new) - we were really happy that Healthy Paws actually covered the cost of the machine and (3)an antibiotic for a few months to deal with the potential infection.
He's had 2 shockwaves and has his third next week. We got the exogen a week ago so have been doing that every day - 20 minutes on each spot - and Perry has been so incredibly patient lying there for 40 minutes so quietly while I hold the ultrasound on his leg.
The vet is going to do a new xray Tuesday to see if we have had any change... and then the plan is to continue the exogen and antibiotics while we're in Kenya and then get a new xray or CT scan when we're back in July to see if we're ready to remove any screws. Then we will do a couple of screws at a time - having to let them heal in between so I assume that means continuing the exogen, possibly packing the area with stem cells or bone marrow to help healing and then considering if we remove the other screws and the plate or not.
I am worried that he's still got pain or something in the foot... he actually was nipping at his groomer on Thursday when she was trying to cut his nails and he's never done that before. I'm going to bring that up to the vet on Tuesday.
Between the leg and his raised liver enzyme levels he's on waaaaay too many meds and supplements.
Leg:
Adequan shots twice a month
Cosequin (joint supplement)
Welactin (fish oil supplement)
Cephalexen (antibiotic)
Gabapentin (for nerve pain)
Liver:
Denamarin
Ursodiol
Zinc
Vitamin E
I also added a probiotic back since he's on an antibiotic and the occasional trazadone to help with anxiety/ when he needs to stay calm for vet procedures, etc.
He doesn't mind being on so many things because it means more peanut butter for him.
Right now we're getting ready to go to Kenya - which means a USAD endorsed health certificate. Our regular vet is so great because you now have to do the health certificates online (which she never did before but she's doing for me) and then, "because of COVID" (in reality I think it just makes their life easier not having to deal with people) USDA is not accepting in person appointments to get the endorsement so it has to be FEDEX/ UPS overnight back to me - so stressing a little about getting it back in time/ before we travel.
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