The Limp, the Surgery, the Dilemma that is Henry.

Henry starts limping in May 2008.

At first we can't tell if he is limping or not. He isn't consistent with his limping and it's just hard to tell. Henry has had a weird, flat-footed walk since we got him because of the interdigital erythema. Finally, we decide it's a limp and off he goes to the vet where he is sedated and x-rayed.

The vet doesn't see anything abnormal in the x-rays but decides to consult with a specialist to make sure. The specialist agrees. The vet does see bone shards in Henry's stomach and warns me to stop giving him bones. He also prescribes pain medication for Henry. I leave feeling frustrated because I didn't learn why Henry was limping...although, I did learn that x-rays and specialists are expensive.

In September, we have our new vet look at his knee. He feels the positioning of the leg in the initial x-rays was improper. He takes new x-rays and combined with the physical exam identifies the culprit as a subluxing patella. His recommendation is to perform surgery to deepen the patellar groove to prevent the patella from subluxing. This is important he tells me to prevent a future ACL injury. Jensen and I decide to go through with the surgery because we believe it will save us money in the long run.

Henry gets the surgery on September 10, 2008. The staff at the vet decorate his bandage with a red heart. This is the first time I am instructed to have Henry on "severe activity restriction." I quickly learn that this is impossible with Henry. We keep him kenneled most of the time but he jumps, pulls, and generally goes crazy when we take him out to "go potty."

At this time, I was just starting my second year graduate school to get my Doctorate of Physical Therapy. If I had received the recommendation to deepen his patellar groove 6 months or so later I would have questioned the doctor. A shallow patellar groove could definitely be a factor, however there are likely more factors (ligamentous laxity, muscular imbalance, malalignment, gait abnormality, soft-tissue contracture). This is important because these factors will continue to effect the knee even if the groove is deepened and therefore may not help the problem at all. And I would have been right!

After the surgery Henry demonstrates morning stiffness and so a few months later, when Henry stops weight bearing on the same leg for a couple of days, we hope it is also because of stiffness. This seems likely as he starts walking normally and being his regular, hyperactive, crazy self.

A few months later we are back at the vet to get Henry's right front limb examined. While he doesn't seem to be limping, we notice that he sits with his right front leg out to the side (abducted and internally rotated). The vet recommends we consult with a specialist about Henry's elbow. He checks Henry's knee as well after we tell him about the limping episode. The physical exam doesn't turn up anything abnormal and the vet thinks it is likely that stiffness caused the limping.

The specialist examines and x-rays Henry's right front leg. The x-rays are inconclusive but he thinks there may be a bone chip in the elbow joint. He gives us the choice of surgery or CT scan. We decide to do the surgery for monetary reasons. A CT scan costs about half of what the exploratory surgery was estimated to cost. If during the surgery they found a bone chip they could remove it and that would be it. If they found a chip with the CT scan then we would have to get the surgery anyway. The day before the surgery, Henry stops weight bearing on his left rear leg. The surgeon decides to do some imaging of the knee and finds Henry has an ACL tear. So we are given a choice: go along with the planned exploratory surgery and try and rehab his front leg with a injured rear leg OR get surgery to repair the ACL and get a CT scan of the front leg. We go with the latter. Henry receives a tibial plateau leveling osteotomy. This surgery affects the mechanics of the knee joint and so the PT in me is satisfied. The CT scans reveal that Henry has a fragmented medial coronoid process in his right elbow with a possible ununited medial epicondyle of the humerus.

Recovery is tough. Henry doesn't believe in "severe activity restriction." We have to confine him to a small room (an inclosed porch) otherwise he runs and jumps around like the crazy, little man that he is. We have to carry him up and down stairs to take him outside. It isn't difficult to carry his little 70 pound frame but catching him and lifting him can be difficulty. I disobey every directive about lifting I've ever given a patient and try and lift Henry while twisting and using only my back. This leads to the humiliating experience of having to call in to my final internship 2 days in a row. At least, I got to be a living example to patients as to why lifting improperly is bad. In addition, activity restriction for this surgery is long.

In July, he is still supposed to be on a leash at all times. I take Henry out to the backyard regularly to enjoy the summer. I start getting lazy and occasionally let him off leash. He is very good and doesn't run around--just stays next to me in the grass. Except one time...a bicyclist passing by the house inspires Henry to run like a bat out of hell across the yard. Once again Henry stops weight bearing on rear left leg.

After a night of feeling like the worst person on earth for giving H freedom we are back at the vet. This round of x-rays doesn't seem as bad. After all, CT scans are way more expensive. The x-rays are sent to the surgeon and after a couple agonizing days we learn the repair still looks good and Henry probably just strained a muscle.

The elbow surgery? Well, that has to wait until Henry's chest is clear of a skin infection for 3 weeks to reduce the risk of infection in the incision. Keeping him on antibiotics isn't helping. Steroid treatments are working but a round of steroids lasts about 20 days and his skin starts getting infected as soon as we start reducing the dose to 1/2 pill every other day. Half glass full: we have more time to save up for the elbow surgery. Half glass empty: treating his skin & allergies is preventing us from saving any money....

1 comment:

  1. Hey, how's my favorite lemon dog? How's treatment for the doggie MRSA going?