Recheck with Surgeon July 10th

I wrote down what I could remember right after Spice's appointment with the surgeon on July 10th and I am posting it today (more than a month later - sorry).

The surgeon was pleased with Spice's progress. He said that his range of motion had improved. Spice was not as
sensitive when he touched his elbow as before. 70-80% weight bearing on his right front leg. Did not protest when he held up his other leg so that he had to put weight on his right leg. Muscle tone was good - no atrophy compared with the other leg.

He mentioned swimming again as a good exercise. I should increase the length and frequency of his walks. (Hard to do when it is hot out).

We should keep Spice from jumping right now and preventing him from doing stairs (not sure if it was 2 more weeks or longer). Again going down is the worst. If he goes down carefully two front feet at a time it isn't as bad. His cartilage still needs time to form/heal. He mentioned 20 weeks (was this how long the cartilage needed and/or how
long until he improved as much as he is going to?). Sometime dogs will plateau before continuing to improve.

In two weeks could try some running.

Can keep icing especially after activity.

By (the end of?) August we likely will have seen as much improvement as we will see. Again this could be the 20 weeks he was mentioning.

If you try something and he is sore, give him a couple days rest and then try the same thing again. Don't need to revert back to something easier unless it repeats.

He thought teeter would be okay and weaves. I think that the teeter might be too jarring for him. Depends on how he does it. Weaves may also be jarring if he tries to do them fast (two footed). Maybe I should use pylons to try to get the weaving motion without jarring.

He said that his elbow may always get sore due to the arthritis.

He felt the soft tissue swelling spot. I said that it was getting better. He didn't seem concerned since it was getting smaller. I could hardly feel it today when showed it to the surgeon.

I explained the types of exercises he was doing (ladder, fit disks, bosu - half ball) etc. He said that I was doing really well - gold star. Especially compared with other owners (dogs are usually overweight and not active - owners don't know about the exercises).

Recheck with the surgeon

Today we went back to the clinic to have the surgeon check Spice. It has been 10 days since his surgery.

The surgeon was happy with Spice's range of motion. The small incision healed well and the bruising is gone. Spice is still sensitive at his elbow joint but there is no swelling. The surgeon could not detect crepitus in the joint. One thing that he noted was that Spice does not want to extend his leg completely. I am not too surprised as I think that it will take some time.

No stairs for 2 more weeks and then he can be allowed to do the small set of stairs going up to the bedrooms. Going up is easier on the joint than going down. We will have to wait longer before he can go down the larger set of stairs to the basement. One thing that the surgeon suggested was to use a harness (tracking harness or seat belt) when Spice is going down the stairs and lift him a bit to take some weight off and reduce the impact.

I told the surgeon that I used a physioroll before to help strengthen Spice. I have the Get on the Ball DVD. He said that we can start ball work twice a week to start and see how he does. I will wait about a week before trying this and will be starting slowly. Yesterday I did some ball work with Taari and Spice was getting excited in his X-pen thinking that he would get a turn. He got cookies instead.

Another good passive exercise is having Spice give me his paw. I will have to review my other DVDs to figure what other exercises would be good.

Up until now I have only been walking Spice about three houses down the street for his bathroom breaks. We can start walking more (6 houses) but it will be a meandering walk. He is not ready yet for 10 minutes of continuous walking but we could just go out for 10 minutes - visiting with neighbours and enjoying the spring weather.

I am at a trial this weekend with Taari and it is okay for Spice to come along and get a massage.

It will take 6-8 weeks for cartilage to form. How Spice is doing will tell us how well things are progressing with his joint. There is a danger of damaging the scar tissue if the surgeon went in again so he will only do it if necessary (i.e. Spice gets worse).

I may find that Spice gets sore during his rehabilitation and if he does then I rest him for 2-3 days. I asked about his cartrophen shots and Spice can continue to get them on his regular schedule (he doesn't need to have them more frequently). I stopped giving him Metacam today. If he gets sore again later today can give him Metacam again for 2 or 3 more days.

He doesn't think that Spice's elbow will get bad enough that it will require more drastic measures - fusing the elbow joint, amputation or elbow replacement. I was glad to hear that.

The surgeon also said that Spice looked good for his age (12 years old).

We will go back and see the surgeon in two months unless he gets worse. Until then we will continue with his physiotherapy. I am feeling more positive about his prognosis.

Update on Spice

Wednesday: I picked Spice up on Wednesday (his surgery was on Tuesday). His leg was very bruised which is to be expected. He has a "poodle" cut on his leg as they shaved part of it. He also missing some fur on his left leg from the surgery. His leg was quite sore.

For the next two weeks he is to be kept quiet. Only going out on leash for bathroom breaks. No stairs, slippery floors, jumping, running, etc. He will need to be kept in a small room or crate when we are not at home. I have an X-pen that I set up in the living room. He also should not lick his incision. I don't like the cones (typical e-collars) and neither to my dogs. So I am going to try the craft foam disk that I made for Taari. I just need to cut a larger hole in it for Spice since he is bigger. This is quite flexible and should prevent him from licking himself. It is Christmas colours since I bought the foam on sale (red and green with some yellow duct tape). As well as ice therapy for the first few days I should wash the incision with warm water. Home physio consists of massage and flexing and extending the joints. I will probably continue with the ice therapy as well.

After two weeks I can start short walks with Spice and gradually increase the time to help build muscles. They recommend 3-5 walks a day which will be a challenge on days in which I work. I think that I can get three walk in (one before work, one when I come home and one before sundown). I will also do some strengthening exercises.

Wednesday night Spice and I didn't get much sleep. He was very restless which I believe was due to pain from the surgery and possibly an upset stomach. They most likely gave him something to eat while he was at the clinic.

Thursday: I worked from home so that I could keep and eye on him. Thursday night we both slept better. I gave him some Slippery Elm to help with his stomach.

Friday: I went to work but came home early since I was worried about him. It was actually Friday when I started using the e-disk on him.

Saturday: His bruising is continuing to decrease. He seems to be in less pain.

Sunday: Again I noticed that bruising is less. I tried not using the e-disk but caught him licking his leg. Not where the incision is but where he was shaved. It is a bit red there so I am wondering if it is irritated. There is also some scabbing on his skin and I wonder if it is because he was shaved or perhaps due to the arthroscopy.

Spice has for the last couple of days wanted to go for more than a bathroom break when I took him out front on leash. I think that he is expecting a walk.

Sunday night when I got home from the trial (Taari was entered in a nearby trial) he seemed to be moving better when he went for his bathroom break. It is good to see an improvement.

Jump Down Syndrome

When I was going home to visit my family I took some Clean Run magazines to read on the plane. While I was reading the Jump Down Syndrome article I thought is this what Spice has?

Spice has been limping for a while and he wasn't putting full weight on his front right leg. Initially I thought that perhaps it was a soft tissue injury or arthritis. I took him to his chiropractor and she could feel heat in the joint and noted crepitus. When it wasn't getting better my vet started cartrophen injections. They seemed to help a bit. I was of the opinion if it was arthritis there wasn't much that could be done other than what I had been doing. Spice is on a variety of supplements - Vitamins B, C, E, Sashas blend, Joint Complex (Glucosamine and Chondroitin Sulfates with MSM), and salmon oil. I feed him a raw diet (Urban Wolf and Healthy Paws).

When Spice was due for another cartrophen injection I took him and the Clean Run article to my vet (Wednesday). I wanted to know if there was something more that could be done. My vet referred me a specialist. She called to let me know on Friday that Spice had an appointment with a surgeon on Monday. Spice had arthroscopic surgery on his elbow on Tuesday. When I picked up Spice on Wednesday I asked the surgeon if I could call what Spice had Jump Down Syndrome. He said it was likely that was what Spice had.

From the Clean Run article by Sherman O. Canapp Jr., DVM, MS, DACVS and Donald Hulse, DVM, DACVS (April 2008 p 78)

"Jump down syndrome" or traumatic fragmented medial coronoid process is a condition in the elbow joint of dogs that appears to occur commonly in performance dogs. Unlike the classic condition of fragmented medial coronoid process (FMCP) affecting the elbow joints of skeletally immature large to giant breeds of dogs, jump down syndrome (JDS) appears to have no age or size limitations.

They say that the cause isn't well understood but suspect that abnormal repetitive loading may cause microfractures of the bone. Landing from a jump, hitting contacts or a flyball box are given as examples. They also discuss other factors.

The treatment according to the authors is multimodal - medical, surgical and rehabilitation.

Arthroscopy - diagnosis and removal of bone fragments
Medical - pain killers, joint protective agents, etc.
Rehab - ice therapy, manual therapies, home exercise program, etc.

Basically as I understand it the bone fragments and pieces of it end up in the elbow joint. When the surgeon examined his right elbow manually it was sore. They took X-rays and found that Spice's right elbow joint didn't look right - possible fragments - fuzziness. His left elbow looked fine. During the arthroscopy the surgeon found pieces of bone in the joint (which he removed). We will have to see how Spice recovers since a fair amount of damage (moderate to severe osteoarthritis) was seen but the surgeon did what he could. I got to see the video of the surgery when I picked Spice up.

My goal is not to have Spice compete again but to make him more comfortable with every day life. If his recovery goes really well we may do some jumpers runs at his double drop height of 6". They do mention in the article that recovery is typically 2-3 months and "return to sport" 4-5 months.