gabby's recovery journal--tibial plateau leveling osteotomy

It seems I'm updating this only to share bad news. Yesterday, injured his left ACL during his walk. It was fairly uneventful. Gabby was a few feet walking behind me when he let out a yelp. I couldn't see anything that might have hurt him except possibly an uneven area between the grass and sidewalk or possibly a main water shut-off just below the grass. Gabby has an appointment Tuesday to see Dr. Riggs. He seems in more pain than his first injury 2 years ago I think because he doesn't have an unaffected hind leg to support him like before.

Gabby walks 3 miles this morning (see map). Today's high was 96°F (35.6°C). I wanted to limit Gabby's activity in the afternoon due to the heat and Gabby's age (12 years old). Gabby tolerated his morning walk well. I've been walking him early in the morning or late at night to avoid the mid day sun and heat. He's been gradually walking further on his walks. It's been 1 year since Gabby had his pins out. Gabby's weight 32.4 lbs.

Gabby's walks haven't made much progress over the winter due to the snow. This spring Gabby has been walking further and further on his daily walks. Tonight, Gabby's walk was 2.2 miles (see map). Actually, his routine walks are still around 1-1.5 miles (2-3 times a day). It's been raining these past couple days keeping Gabby inside. Tonight there was a break in the rain and I took advantage of it. Gabby tolerated his walk well and actually tried to go further but I wouldn't let him. Gabby still has a limp. Some days it's more noticeable than others. Gabby continues his hypoallergenic diet. There's only been a couple of days where Gabby limped severely. Once incident turned out to be something stuck in his paw. We're not sure what happened the other time.

Gabby takes 1 mile walks on a routine basis sometimes twice a day and tolerates them well. Gabby recently experienced illness which left him listless. After his surgery, Gabby began passing blood in his stool which I attributed to stress. He was seen by his veterinarian who believed it may be caused by parasites due to his unhealthy taste for dead animals. Unfortunately, her treatment did not cure his bleeding. Last month the bleeding became frequent. Gabby's health began to decline (you could see it in his eyes) and seemed to be suffering from abdominal pain and gas. I took Gabby to Dr. Clooten, a specialist in internal medicine. She did an ultrasound which found a slightly enlarged liver but no life-threatening conditions. She suspected colitis due to some type of inflammatory disease. She sent Gabby home on antibiotics and Royal Canin Hypoallergic dry food. Gabby's bleeding seems to have improved and his stools are better formed. Also, Gabby's health has improved. This prescription diet is difficult for Gabby who is used to enjoying dog treats and occasional table scraps. We've cheated and tried giving him table scraps which resulted in severe gas and diarrhea. It seems every walk I take Gabby on ends up with him finding some sort of edible garbage for him to eat. I've though about muzzling him during his walks to prevent eating of any sort.

The cold weather has made Gabby's walks difficult. We've had freezing wind chills and Gabby's belly was shaved for the ultrasound he recently had. I've been putting Bag Balm and Gabby's front paws to prevent cracking due to the ice and snow.

Gabby takes his first 1 mile walk on 11/16/05. Gabby's current weight is 30.5 pounds.

Gabby's taking 0.9 mile walks! Gabby is doing better and his walks are getting longer (see map). I'm able to walk him to Marcy Street and back. Gabby usually does this 1-2 times a day with a shorter walk as well totaling 1-3 miles per day. Gabby had me worried last week as he was not feeling well: He was moving so slowly. Normally, Gabby is pulling me along with his leash. It lasted for about three days. I thought the cold weather might be bothering him. I called Dr. Riggs to let him know. Gabby was better soon after and has been doing well since then but I'll keep an eye on him.

Gabby's limp worsens. We took Gabby on his first vacation since his surgery to a quite cabin on the lake for 4 days during the 2nd week of September. Gabby loved it. Afterward, Gabby began limping badly at home. Gabby's progress he had made on his daily walks was set back. Slowly, I increased Gabby's walks and he is able to walk to 9 Mile again. Gabby is also having other health problems. I don't think Gabby's limp will get any better. We'll just make the best of it.

Gabby makes it to the end of the block! Gabby was able to walk from our house all the way to 9 Mile Road round trip (1286 yards). See map.

Gabby had his checkup yesterday at doctor Rigg's office. Gabby can resume normal activity on a gradual basis. He has no plans of removing Gabby's TPLO hardware (plate and screws) unless infection develops as the site. If needed, Dr. Riggs would prefer to remove his hardware in 6 months when Gabby's bone has fully healed. He said Gabby could go on a trip with us next month as long as he didn't over exert himself. We'll have to see. This has definitely been a hardship for the whole family. Gabby gained some weight back (32.5 pounds).

Gabby is doing fine. The first couple of days after the pins came out there was heavy drainage from the top pin site. After a few days the drainage became scant. There hasn't been any drainage for about 5 days. Gabby has a slight limp--I guess he'll have it for the rest of his life. The also something called crepitus when you move Gabby's knee. It's the sound to bones make when the rub together. I guess this is a result of arthritis building up in his knee joint. I'll ask the vet about it when I see him in a week.

Here are a few observations I've made on my own during Gabby's recovery. Signs your dog is recovering from TPLO surgery:

Number for took the longest on Gabby. When I tried to left up Gabby's good leg, say when drying his wet feet, Gabby would go down on the ground. It wasn't till today I noticed Gabby could manage to stay up on his operated leg when I did this--4 months later!

BTW: Gabby lost 7 pounds and 11 ounces during his long convalescence (from 37 to 29.3 lbs) . Gabby needed to loose some weight. I just wish didn't happen under this circumstances.

Gabby has another appointment on July 12, 2004. Dr. Riggs plans on taking out the remaining pins even if his bone is not healed. The drainage from Gabby's remaining pins has decreased significantly--they look dry for the most part. About a week ago, I noticed some possible drainage as the fur around the site felt damp. I haven't noticed any drainage since then. Cleaning his pins is so much faster and easier on Gabby now that the pins have dried. It took about a week for the top front pin site to finally heal. I'm still putting Neosporin ointment on it to make sure it heals well. I'm surprised Gabby's remaining pins have stayed in place considering how loose they are.

Gabby walks rather well now. You really can't tell he has a limp although the shape of his leg has changed since Gabby's former surgeon, Dr. Jackson, chose to lengthen it for some unknown reason. As a result, Gabby looks like he walks bowlegged. My wife is thinking about suing Dr. Jackson for not treating Gabby's infection appropriately. Gabby's infection didn't get treated until we saw Dr. Riggs.

Unfortunately, Gabby spent his 11 birthday convalescing. I bought him a plush toy which he discovered days before his birthday so I let him have it then.

I have good news and bad news. The good news is Dr. Riggs removed two of Gabby's pins. The bad news is Dr. Riggs didn't want to remove the them except the bone around them was eroding to the point he though Gabby might develop a stress fracture. The other bad news is Gabby's bone hasn't healed much since the last x-ray--that's why he didn't want to take out the pins. Dr. Riggs will see Gabby again in a month and take the other two pins out whether Gabby's bone has healed or not. He doesn't think they'll be doing him much good if he leaves them in any longer. We just have to hope the TPLO plate and screws on the inside will be enough to hold his bone together. I've included pictures of the pins Gabby had taken out of his leg (2nd picture of pins). You can click on the pictures for a better view. These pins were sticking out of the top front of Gabby's shin bone. The remaining pins are much thicker and are in the medial aspect of Gabby's shin bone. That's what was underneath Gabby's bandages.

I've been cleaning these pins every day since April 18, 2005. Every day I take Gabby down in the basement, set him on a table and clean his pins as I've described earlier. Gabby's been a good sport about it but I can tell it makes him depressed. Since the first two pins were removed Gabby is feeling a lot better. They must have been painful. The bottom hole in Gabby's skin has healed were the pin was. The top hole is still open since there is some drainage that comes out. I'll be keeping a close eye on it. He's also able to move around faster. So far the drainage has really decreased since those pins have come out. We still go down to the basement but it only take me half the time as I'm doing half the work now.

The antibiotics continue to upset Gabby's stomach. I've been giving him Zantac the vet said it was okay but would prefer we give him Pepcid. I forgot to buy some yesterday. Gabby is still on the Keflex. Oh, Gabby's been in an e-collar since April 17, 2005. I'm an expert at putting his e-collar on. I even modified it so I can put it on quickly.

Gabby has another appointment June 14. Hopefully, the x-rays will be okay and Gabby's pins will come out. Yesterday, I gave Gabby his last Baytril. I started him back on the Keflex until our appointment however there's a noticeable amount of increased drainage from Gabby's pin sites. I called the Oakland Veterinary Referral Services (OVRS) and asked what I should do. The vet on call said Gabby should be fine until his appointment on Tuesday.

It's been a while since I last wrote about Gabby. About a week ago, my wife noticed that there was some blood on Gabby's belly. I took a look and saw there was some bleeding at the top pin sites. It appears that Gabby's external hardware got caught on something and possibly tugged. The pins were still in. The bleeding (just oozing) stopped right away however Gabby's leg was sore and he limped for a couple of days. The antibiotics are making Gabby's stomach nauseated. I've been having to give him over-the-counter Zantac so he can keep his pills down. I time them apart from his antibiotics so they don't interfere with the absorption. Gabby passed some blood in his stool several days ago. It hasn't happed again.

This morning Gabby greeted me at the picture window as I came home from work. This is how Gabby has always greeted me in the morning. I always looked forward to Gabby's blank expression in the morning. Gabby must feel better! This morning I could not notice a limp in his leg. I'm so glad things are starting to get better. You know, I changed Gabby's dressings for 10 days (most of these dressings changes were twice a day) and have been cleaning his pins for 40 days. It's not an experience me or Gabby ever want to go through again.

I've always took for granted that I worked in a hospital exposing myself to many germs but since Gabby's leg became infected I've become conscientious about not bringing germs home to Gabby.

Gabby has definitely had more drainage over the past few days. I can tell as it takes 2-3 x longer to clean his leg. Mostly, I'm cleaning up drainage that has dried in his fur which becomes hard and matted. Gabby is back on the Baytril. Other than the heavy drainage, Gabby is doing fine.

This evening after I woke up (work 7p-7a) my wife tells me Gabby was in a fight with another dog last night! She should have told me first thing this morning! She was potty walking Gabby on our street when a dog ran from his house and attacked Gabby. She says they were "rolling around on the ground fighting." Luckily, nothing happened the fight was broken up right away. Gabby is in no position to fight right now. What if that dog would have pulled out Gabby's pins? What if that dog would have broke Gabby's leg? At the very least, Gabby probably had to use his injured leg more than he should have do defend himself. I tried to have a word with this neighbor. I don't think he realizes I've spent over $7000.00 on Gabby's leg and his dog could have ruined his surgery.

Last night when I was washing Gabby's pins it looked like there was heavy drainage but I'm not sure if wasn't the result of the gobs of Neosporin I put on his pins every day. He has been having more drainage since the Doctor took him off the Baytril. The drainage looked yellow-brown but I'm not sure if it was just the Neosporin that had gotten dirty. This morning it looks okay so I'll wait before calling the doctor.

I've contemplated putting Gabby's medical bills here however I want those considering TPLO surgery to know just how costly it can become when there are complications. If Gabby's first surgery wouldn't have had complications then his bills would have only totaled around $3,000.00. Poor Gabby had many complications including a broken screw and a severe infection. Here is a table of his bills so far. Keep in mind Gabby still needs another surgery to remove the TPLO plate and screws because they might be infected.

Date	Location	Reason	Cost
2/5/05	East Suburbs Pet Emergency	Injury	215.00
2/14/05	Michigan Veterinary Specialist	TPLO Surgery	2,945.38
2/27/05	Michigan Veterinary Specialist	Emergency Room	125.30
3/17/05	Michigan Veterinary Specialist	Follow-up	164.00
3/23/05	Michigan Veterinary Specialist	TPLO Surgery	2,623.67
3/28/05	Michigan Veterinary Specialist	Follow-up	35.00
3/30/05	Michigan Veterinary Specialist	Follow-up	78.00
4/2/05	Michigan Veterinary Specialist	Emergency Room	79.00
4/5/05	Michigan Veterinary Specialist	Follow-up	104.34
4/12/05	Oakland Veterinary Referral	Follow-up	316.00
4/21/05	Oakland Veterinary Referral	Follow-up	337.00
5/12/05	Oakland Veterinary Referral	Follow-up	229.00
Total			7,251.69

In the end, Gabby's bills just for the TPLO of his right hind leg might total $10,000.00. I'm still upset about the emergency room visit we had 4/2/05. I'm sure he had an infection at that time but the doctor disagreed and would not treat him. I've spent about a $1000.00 dollars since that visit trying to save Gabby's leg from a severe infection.

Gabby has been very frisky lately. Gabby's limp was barely noticeable this morning when I got home from work. He's back to his bad habits of begging food from my wife. I keep thinking to myself, "Does Gabby really need this third surgery?" I just want to be done with this whole ordeal. One thing that I forgot to mention in our last vet appointment was that Gabby's "tibial thrust" was still present after his surgeries, according to Dr. Riggs. The whole point of Gabby having this surgery was to remove the tibial thrust. Was all of Gabby's suffering for nothing?

Gabby is doing well. I was worried after he was jostled around in the car accident. I really hoping all goes well and Gabby gets his pins out next month. I'm planning on taking him around the 12th but I'll wait till my work schedule comes out so I can plan the date. Gabby is really sick of wearing the e-collar. The last couple of times he hid when I tried to put it back on. I haven't taken a picture of Gabby lately. I'm wondering why the hair on his back where they shaved him hasn't grown back yet. It's still bald. Although, the hair on his operated leg has grown back.

Gabby went to see Dr. Riggs again today for a follow up appointment. They did x-rays and there is more healing but the bone is not completely healed. Dr. Riggs still saw a gap between the bones where they were cut. We have a follow up appointment in one month. He plans to take x-rays again at that time. If Gabby's bone has healed by that time he will take out the pins. Dr. Riggs feels the infection is under control now and has place Gabby on different antibiotics that aren't as strong (keflex 250 three times a day). He's keeping Gabby on antibiotics just to make sure his heart valve does not become infected.

Would you believe we got in a car accident on the way back from the vet? Yes, we did. My wife drove as I sat in back with Gabby. Gabby was sleeping on his oversize pet bed. We were in busy traffic when everyone stopped suddenly. We almost hit the car in front of us but stopped in time. Unfortunately, the car behind us hit us and scraped our bumper. I saw Gabby roll forward in his bed without hitting anything however I suspect he might have hit the back seat then roll forward. Between having his dressing changed at the vet and the accident Gabby is limping a bit more right now. The accident happened about a hour ago.

Gabby has had his good days and has his bad days. Overall, his limp has improved. Dr. Riggs thinks most of his pain is from the pins being loose. He thinks once they come out Gabby will feel much better. I'm hoping that's the case. I'm going to let Gabby rest a few hours then I'm going to clean his pin sites.

Gabby is doing well. The last couple of days Gabby has been very active and more like his old self since his injury. Actually, this makes it harder on him. He wants to run and jump and play. We have to watch him because he'll try to do too much. The last thing we want is another complication. Me and my wife are wondering if his bone is close to healing and maybe that's the reason he's been feeling so well.

This has been a very trying time in our lives. I WILL NEVER PUT GABBY THROUGH ANOTHER TPLO SURGERY. I don't know if I could have taken care of Gabby at home with my nursing experience. My wife and I were doing dressing changes twice a day. My wife is a registered nurse too. Michigan Veterinary Specialist left us high and dry without supplies to care for him. The last time I asked for supplies I was told, "we can't give you more than this without charging you for it." I had to hunt all over town for his supplies and wound up buying them at a medical supply store. Caring for Gabby was just like caring for a patient in the hospital needing lots of care. I think the average person would be overwhelmed caring for a sick dog as we did.

Gabby has changed so much since his injury. I used to get comments about Gabby being so muscular, "you must walk this dog every day." Before Gabby's injury if you would pick him up you could feel his muscles in his chest, legs and everywhere. It was like picking up a rock. Now Gabby has lost weight and his muscles are flaccid. He feels more like a puppy when you pick him up. I'll do my best to get him back in shape when this is all over. He wants to go for long walks so badly like we used to.

Gabby's leg looks good. I've noticed that there is drainage coming from the front top pin site when there was none before. The others pin sites are dry. The drainage is clear and there always seems to be dried blood around this pin. All I can do is keep it clean and hope it doesn't get infected. Gabby's limp is less and less noticeable. He seems to be using his leg more and more. Let's hope his leg is healing well.

Many of you have asked about Gabby. I'm sorry to have not kept you updated. Rest assured Gabby is well. It seems I never have enough time at home anymore. On April 26, I took Gabby's sutures out. This was one of the questions I forgot to ask Dr. Riggs, "when are you going to take out Gabby's stitches?". At the time I believe he was worried just about saving his leg and Gabby's sutures were not a priority. Thirty days are too long for sutures to stay in the skin. It leads to problems such as infection and become difficult to remove. Gabby's infection had improved. The incision and pin sites were no longer oozing pus. I scrubbed Gabby's incision site with Betadine then used a suture removal kit to remove his sutures. Most of the sutures were daisy chained together tunneled under the skin. A trauma surgeon I've worked with does a much nicer job. After removing the sutures a small area (the size a paper hole puncher would make) opened up. There was no bleeding but the flesh could be seen underneath. My panic level rose 100%. However, if Gabby's incision couldn't heal after 30 days it's unlikely it ever would. I imagine this opening was the result of Gabby's infection. Old dead skin with tufts of hair came off after scrubbing with the Betadine. Right now the incision looks good and is healing nicely. FYI: I'm a registered nurse and feel quite comfortable removing sutures at work. See your vet for suture removal.

Little by little Gabby's limp is improving. I was disheartened earlier during Gabby's infection because Gabby lost the ability to lift his leg to pee using his bad leg. Gabby hadn't been that debilitated since the day tore his ACL. The swelling is gradually going down in his leg. There's very little or no drainage from Gabby's pin sites--none from the incision. The scant drainage now is just serous (top inside pin) although the top front pin always has a little dried blood.

Every day I clean Gabby's 4 pin sites (those are the screws sticking out of his leg). It's much better now that the drainage is minimal. Before, I was doing it twice a day. Now I'm doing it once a day. Dr. Riggs recommended we wash his pin sites a couple times a day with soap and water--that was during the heavy drainage. Every day I take Gabby down to the basement where I cut his hair and scrub his pin sites with clean water and benzoyl peroxide/sulfur soap using a sterile cotton tip applicator. Then I use a 10cc syringe with a 25 gauge needle and rinse the pins off with sterile .9 normal saline (the 25 gauge needle makes a fine spray). I dry the pin sites off with a sterile cotton tip applicator and apply Neosporin ointment to each site. It takes me about 30 minutes to do. Gabby doesn't like it but is used to it. There are days when I'm just sick of doing this but it has to be done.

Gabby's pins stick outside his leg. The pins are wrapped with dressing so they don't get bumped and don't dig into Gabby's groin. I've had the same dressings on since April 21st and they look dirty and smell. I haven't touched them since Dr. Riggs said the pins are loose. On April 30th I did change one of these dressings covering the inside top pin. The pin site had been dry for day then I noticed some red discharge and became concerned about another infection. With my wife's help we changed the dressing but it turned into a fiasco. The pin is VERY LOOSE and Gabby would not hold still making me tug on the pin. I was afraid the pin was going to come out. Gabby was in a lot of pain afterwards and we gave him a pain pill. If these dressing need to be changed the vet will have to do it from now on.

Gabby's limp is worse again after walking the 2 stairs between are garage and backdoor. The first vet tech said Gabby could climb small amount of stairs like this as long as it wasn't a flight of stairs. Dr. Riggs wasn't in to let us know if Gabby could take his pain pills although they said Gabby's alkaline phosphatase (alp) was 338. Which is high. ALP is a enzyme used to check liver function. My wife and I looked at one of our nursing books and saw it could be elevated due to bone growth which is probably happening on Gabby's surgically fractured leg. All his other lab test were okay. I went ahead and gave him one 25mg Deramaxx pain pill because his leg was hurting him so much last night.

For a couple of day's now I've noticed Gabby's leaky pin site has started to dry up. I don't know if that is good or bad. Is there more fluid that's trapped inside and needs to come out? Gabby's leg is still swollen, especially around the knee, so I wonder. I'd be less concerned if there were no swelling at all. I understand some of the swelling is due to the bone healing but just how much. At least his pin care is a lot quicker and less involved because I'm not cleaning up all the excess drainage.

Gabby had his checkup yesterday with Dr. Riggs of the Oakland Veterinary Referral Services. Yesterday when I was getting Gabby down from the car he banged his operated leg on the inside of the car door. It must of hurt because his limp worsened afterward. He's better today. Dr. Riggs pulled on Gabby's pins and they moved slightly. He said the pins were loose and there wasn't much he could do. He must think Gabby's leg is still infected--that's why he wouldn't operate on him right now (i.e. to tighten the pins) because he's keeping Gabby on antibiotics. NOT THAT GABBY OR I WOULD WANT ANOTHER OPERATION. He said Gabby might experience more pain if the pins are loose--nerve endings will start to grow into the dead space. He thinks Gabby has been walking too much on that leg and the pins are loosing up. He also said there will be more drainage if the pins are loose. Only the top pins from both sites are loose. He says the top pins are more likely to become loose due to where they are. The top pins are located in head of the tibia which is composed of spongy bone (see drawing). Spongy bone is very light with a honeycomb framework. The lower pins are in the tibial shaft which is composed of thick hard compact bone. Gabby's lower pins aren't moving.

Dr. Riggs says that even though some of the pins are loose they are still helping to hold Gabby's bone in place. The risk is the pins will become so loose that they will fall out. If the pins fall out Gabby will lose the support they have been providing. Now, it a race against time as Gabby's bone must heal before the pins fall out. Dr. Riggs isn't sure yet what he will decide if the pins fall out. I don't know how encouraged Dr. Riggs is with Gabby's leg as he mentioned the possibility of amputating Gabby's leg not once but twice. Gabby's will remain on the same antibiotics for another 21 days. My wife asked about pain medication for Gabby. The doctor is reluctant because Gabby's liver enzymes were elevated. They took Gabby's blood to recheck it. Dr. Riggs gave us some more Deramaxx for Gabby's pain. Depending on Gabby's blood work Dr. Riggs will give us the okay to give them to Gabby.

There's been consistent heavy drainage from Gabby's top inner pin site except for this morning--it looked dry.

Today was Gabby's last day of antibiotics. I hope he can manage now without them. His infection has really improved. Still a lot of clear discharge from the top inside pin site. The swelling has really gone down there. This morning I noticed some swelling in Gabby's right groin (operated side). I think the lymph nodes are swollen as his body tried to deal with the infection in his leg. I'll make sure and let the surgeon know on our checkup the 21st. This morning while I was cleaning the top inside pin site. I noticed it had a slight brownish tinge (sanguineous?). I think it was old blood. The swelling had gone down enough that I could see some of the tissue underneath the skin.

Gabby's infection is better. Dr. Jackson, Gabby's original surgeon wanted to wait until this week to see Gabby again. Who knows what would have happened if I waited till now to have Gabby seen. That's why I went for a second opinion. I had no ideal 6 day's ago Gabby's leg was filled with pus until Dr. Riggs drained it. The incision site and pin sites have all improved. Although there is still heavy drainage coming from Gabby's inside top pin site. The drainage is serous (clear). About twice a day I clean Gabby's pin sites and incision site with a medicated soap that contains sulfur and peroxide. Most of the cleaning I do is because that top inside pin is creating so much drainage. The other pin sites are clean and dry except for the top front pin site which has a little bit of dried blood. The fluid filled pocket between the inside pins has gone down. The only swelling that remains is on Gabby's knee joint. Gabby seems to be walking and feeling better than 6 days ago except Gabby is still not using his operated leg to walk on like he did before he fell in the back of my car 4/5/05. One thing I have noticed is Gabby can no longer pee lifting his good hind leg (putting weight on the operated leg).

I think something maybe seriously wrong with Gabby's leg still. Dr. Riggs had explained how Dr. Jackson had put 5 screws into Gabby's top of his tibia (all within about 1/2 inch). Gabby's just a small cocker spaniel and this may have been too much. My theory is when Gabby fell in the back of my car the top of tibia was so weak from all the holes that it cracked. I believe that is the cause of his lameness, pain and swelling. Dr. Riggs was unable to see the top of Gabby's tibia because of all the metal hardware. He could only guess to its condition. I see the Dr. Riggs again on the 21st. Let's see what happens. Gabby has run out of his pain medication. The doctor did not give me anymore because he thinks Gabby will feel better after the infection is down. Yesterday was rough on Gabby but he seemed to do well this morning. Let's see what happens.

I took Gabby to another surgeon in Bloomfield Hills, Michigan for a second opinion. Dr. Jackson at Michigan Veterinary Hospital didn't not want see Gabby for another week. Dr. Riggs took the time to explain Gabby's situation. He said Gabby's surgery site was infected. He took the 2 staples that Dr. Jackson put in and lots of puss oozed out. I asked him to tell me the worst scenario. He said the worst thing that could happen is the infection could spread to Gabby's blood and infect his bad heart valve and he could die. He also said the infection could spread to Gabby's knee joint and he could lose his leg. The first thing he recommended was changing Gabby's antibiotics. He put Gabby on Baytril 68 milligrams and amoxicillin 300 milligrams every 12 hours. He doesn't know how far the infection has spread. If the infection has spread to Gabby's steel plate and screws he recommends taking them out. What he recommends is trying the antibiotics for 2 weeks. He thinks the infection should improve in 3 days. He's also want us to leave off Gabby's dressings so the air can get to it (helps get rid of the infection). However Gabby is cannot lick the pin sites so Gabby has to wear the e-collar UNTIL HIS BONE HEALS (AT LEAST A COUPLE OF MONTHS). If it means saving Gabby's leg I'm all for it. In his opinion, Gabby's recovery will take longer than the 8 weeks Dr. Jackson suggested. Dr. Riggs said they do not do TPLO surgery on small breeds like cocker spaniels because the more traditional surgery (DeAngelis technique or Lateral Retinacular Imbrication) works just as well in smaller breeds like cocker spaniels. He also pointed out TPLO surgery is more difficult in smaller breeds because of the smaller size of the bones.

I'm changing over to Dr. Riggs because he has provided me with more information about Gabby's condition than Dr. Jackson. Also, I think Dr. Riggs treatment plan is better. I'm hoping Gabby's leg will improve after 3 days of antibiotics and then I'll know I made the right choice. This has been a mentally and financially exhausting ordeal. On the bright side, Gabby won't have daily dressing changes any more. They were painful for him. My wife is happy about not doing the daily dressing changes too. Gabby will have his pin sites cleansed with soap and water ever day though.

Gabby's limp is probably the worst I have seen so far. He moves like a turtle when he walks. Yesterday and today were pleasant and warm days. If Gabby hadn't of hurt his leg we would have walked several miles yesterday. I probably would have taken him on a three mile walk yesterday evening. I was curious what Gabby's wound looked like when we changed it today. We changed it around 1:00pm (24 hours since last dressing change). The dressings were unexpectedly dry--not sopping wet as before. As I was pulling off Gabby's inner dressing (the one closest to his belly), a staple came with the dressing. I wasn't even pulling that hard. Later, another staple came off with the dressing. I had thought Gabby's wound had deteriorated so badly that the staples didn't hold. No, these were extras. I figured he had a difficult time putting the staples is such a tight spot (between the hardware). There were 2 staples intact in the incision area as he stated. Although the dressings were fairly dry there was an obvious yellow discoloration, a sign of infection. The yellow drainage was mostly around the incision site not the pin sites. Hopefully, the infection will respond to the antibiotics. Last time I saw the inside of Gabby's shin bone the area was painfully swollen. This was where the fluid filled pocket was. This time the swelling had dramatically subsided. Along with the fact there was very little drainage (compared to before), I suspect the doctor drained the site--probably where he put the 2 staples. I wish I was told what's going on. I don't like being kept in the dark about information like this. I've included a picture of some of Gabby's dressings. Just to show you the vivid luminescent yellow drainage. Click on the picture to enlarge. My photo software gave it a green tinge that really didn't exist.

Today Gabby went in for his 2 week check up. Gabby's dressing had been on + 24 hours since we changed it last. We suspected it might be wet and needed changing before that but we wanted the doctor to have an accurate assessment of the situation when he took off the dressings at the hospital. I forgot to bring in Gabby's old dressings that had been changed by us since his last unscheduled "ER" visit (2 extra dressings changes since 5/2/05). We left the hospital feeling unreassured in Gabby's condition and prognosis. They whisked Gabby to the back and changed his dressing. Dr. Jackson appeared to have 3 appointments at the same time. Later, Dr. Jackson told us he put 2 staples in Gabby's incision. It appears I was right when I suspected Gabby's surgical wound was dehiscing (splitting open). Poor Gabby! Staples aren't too bad but they still hurt! He told us to add more bulk to Gabby's dressings to get rid of the "dead space" above the pin sites. I would have liked to see Gabby's wounds before they bandaged him up so I could get an idea of what's happened since the last time my wife and I had changed them. Gabby is in A LOT OF PAIN. We told the doctor we ran out of pain medication today and needed more. Dr. Jackson put Gabby on 75mg of Deramaxx every day until his next appointment in 2 weeks except we were only given 9 days worth of pain meds. Let me make sure and tell her she only gave us 14 tablets. He's supposed to take 1 and a half tablets a day. We're having to buy our own dressing supplies for Gabby. For now, he recommends changing Gabby's dressing every day. The colored bandage you see on Gabby's leg is called CoFlex. It's an ideal bandage for Gabby because it's stretchy and sticks to itself but it's also expensive. How can I tell Gabby is in pain? He whimpers. He trembles when he breathes. Also, he has trouble sleeping. Plus, the fact his limp has worsened. I wish they could give him something stronger.

Looks like my program at the top lost a day because it should be Gabby's 12th post-op day. Gabby's leg is not doing well but he remains in good spirits. The swelling on the inside of his leg has tripled. There's heavy drainage from both pin sites. I was debating putting on his e-collar before I left work yesterday at 7:00pm. My wife thought he would be okay. He's already taken off one of his dressings. I'm still learning how to make them tight enough that they don't come off. I'm just afraid of making them too tight and causing him pain. When I came through the front door I discovered Gabby had taken off one of his dressings leaving the pin site exposed. He hasn't bothered with them before but now with the increased swelling, pain, and wetness they must bother him. I just took him outside to go potty as is. When I brought him in I changed his dressings. I cleaned the pin site where he removed the dressings with Betadine solution then did his dressing. His incision is becoming moist from all the drainage and I'm afraid it going to open up. His surgeon won't be available until tomorrow. I could take him in now but I don't think anything definite will be done until his sees his surgeon. So I'll wait. If needed I'll change his dressing again tonight--there's so much drainage.

One of the reasons I created this journal was so anyone wanting information on this type of surgery (TPLO) could read about it. Gabby seems to have become an unfortunate case. Things just seem to be rolling downhill and I don't know when it will stop. All I can do right now is hug Gabby and let him know that I love him. There's no turning back once they do this surgery because they have to cut the bone in two and you're stuck with a broken leg. Me and Gabby have no choice but to see this out until the end.

We just came back from the hospital after having Gabby's leg looked at. Tonight around (6:00pm) was the first time we had to change Gabby's dressings. I told the vet I didn't have a problem with it since I'm a registered nurse with 13 years experience. One of Gabby's dressings, the one on the inside, had a lot of dried blood which made it extremely difficult to remove. I ended up moistening the bandage with sterile saline so I could remove it. It was very painful for Gabby. I could feel a fluid filled pocket on the inside of Gabby's shin bone. Watery bloody fluid came out of the top pin site when I touched the area. His old dressings also had an unpleasant odor of pseudomonas--a familiar smell if you ever changed bed sore dressings. All this concerned me and I took Gabby back to the hospital. They say Gabby's wound is not infected but there is a fluid filled area inside his leg. I will take Gabby back for a recheck next week.

Gabby was doing extremely well. Last Monday, 3/28/05 I took Gabby in for his dressing changes. The vet was impressed on how well he was walking on his leg--I was too. Not more than 20 minutes later, as I was driving Gabby home, Gabby slid off the back seat onto the floor and hurt his leg. He's been limping and in pain ever since. I took him back to the vet on 3/30/05 to have x-rays. The vet said the steel pins, screws, and steel plates were fine. That was a great relief. When I saw Gabby limping after he fell in the car I cried. This poor dog has already been through 2 surgeries. If there was ever a time I could go back in time and undo the past THIS WOULD BE IT! Although I was reassured by the vet, I won't be at peace until Gabby's pain and limping goes away.

The swelling has gone down quite a bit. Gabby is active again. I came home from work this morning and Gabby was frisky and playful. Gabby was walking well on his operated leg when I took him outside.

Gabby's urinary incontinence appears to be diminishing. He hasn't eaten his dog food but ate a piece of stale bread and a Greenie. No poop yet. He was constipated after the first surgery as well. I think the urinary incontinence may be due to the spinal anesthesia. Inability to empty your bladder (urinary retention) and constipation is a side effect of spinal anesthesia. Here's a couple pictures of Gabby's operated leg. Click on the pictures to see. The one of Gabby's leg is a bit gruesome. The green dressings are around the pins going sticking out of Gabby's leg. I haven't seen underneath but I imagine their are 4 pins (2 under each dressing). They used different sutures this time. Please let this be Gabby's last surgery. My worst fear is the bone will become infected from the pins and Gabby will have to have his leg amputated.

Gabby has become incontinent of urine. He peed his bed and he peed on the kitchen floor. He's whimpered in pain so I gave him some of his Metacam pain medication. The leg is very swollen compared to his first surgery. There must be a lot of internal bleeding. If you ask me right now was the surgery worth it, I'd say no. Ask me again in 8 weeks.

Gabby is home. There's a quite a bit of bleeding around the pins. The doctor said they dressings they changed this morning were bloody. Gabby's leg is really swollen this time compared to his first pre-op day February 15. He went out and peed. I brought him in the house. He just stood and looked at us pitifully then laid down. I gave him a Greenie, one of his favorite treats on the ride home from the vet.

Gabby's surgery was successful. Dr. Jackson from the in Southfield Michigan performed his surgery as well as the first. I believe he said he did the surgery as before with the addition of pins on the outside of Gabby's leg called external fixation. This will be harder to take care of. I wonder if Gabby will have to wear a e-collar through the entire time?

I dropped off Gabby. They said he would be the first one operated on today and I should hear from them by noon. I can't tell you how disappointed I am. My wife says, "you've been letting him do too much." I'm glad I could get Gabby operated on quickly. He seemed to be in quite a bit of pain. I'm determined to make sure this is Gabby's last surgery--one was too many. I'm so sorry Gabby for putting you through this!

Gabby's limping was not without reason. He had repeat x-rays that showed his screws had busted and the bone had moved. Gabby is going back to surgery tomorrow morning. Same as before but this time they're added pins outside his leg the length of his shin bone.

Yesterday, I took Gabby to the vet after he started limping badly. I was so worried something happened to his surgical repair. The vet thinks I've been letting Gabby do too much lately. They did a x-ray of his repaired leg and everything looked okay. Their was even a small amount of new bone growing where they cut his tibia in two. This was the first time I had seen Gabby's x-ray and it was not at all what I expected. Below is a diagram (copyright Dr. Degne) showing what the tibial plateau leveling (TPL) procedure looks like:

The TPL procedure involves cutting the head of the tibia off then angling the head of the tibia level. As you can see from this diagram the two pieces of bone are fastened close together with a steel plate and screws; there's hardly any space between the two. Below is a my drawing of what this procedure looks like along with a drawing of what Gabby's x-ray looks like:

My drawings are a bit exaggerated but I would estimate there's a 1/8" to 1/4" inch gap between Gabby's tibial shaft and head. When I saw this I thought in disbelief, "Gabby's been walking on this?!" Gabby's bone will heal when that entire gap is filled with bone--there's a lot of filling to do!

I'm taking Gabby on potty walks only--just far enough that he can have bowel moment. However, there will be no more playing with dogs in the parks or reaching for toys on the filing cabinet. Gabby's incision looks like it's finally healing. There's no redness or swelling but it looks scaly.

It bothers me so much to see him limp in pain but it bothers me to see him cooped up in the house. I'm really disappointed. I wonder if it was really worth putting him through that surgery. He doesn't seem any better off than before. In the mean time, he's a prisoner in his own home.

Gabby limp worsens. He had been doing so well. Gabby was walking so well you could barely notice his limp. I took him to the park and he met a Brittany. He was on his leash but I let him run a short distance towards her. Later in the day I Gabby was reaching to get a toy off the filing cabnet. I think all this activity was too much for Gabby.

I am disappointed in the appearance of Gabby's incision. There's a small fissure that has developed near the incision. Today was the last day of antibiotics. Although the wound really doesn't look red like it did before. Gabby hates the e-collar but it will have to stay on until this wound heals. Gabby is the kind of dog that will lick a sore till it bleeds.

How do you provide a nice walk when your dog is on restriction? Gabby has been taking daily walks ever since he was a pup. We go for long walks usually a mile or more several times a day. Gabby is only allowed to go outside for potty walks. Walking him in the back or front yard is getting old quick. Plus, Gabby usually poops after walking a quarter of a mile. To spice up his walks (and help him poop), I put him in the car and take him several streets away. This is exciting for him. He gets to set foot where he normally couldn't (due to his restrictions). He usually poops very quickly and gets to enjoy a short walk in a new environment in the process. As soon as he poops I clean up the mess and bring him home.

Gabby's infection looks better! The antibiotics and e-collar have helped. Gabby had his 2-week follow-up yesterday instead of Friday. Dr. Jackson (his surgeon) was satisfied with his progress so far. He was also satisfied with the appearance of incision. I thought x-rays would be taken yesterday but not until his final check up 6 weeks from now.

Putting the Elizabethan collar (e-collar) on Gabby the first time was a battle of the wills! Gabby must have thought is was some sort of deadly weapon and fought tooth and nail when we tried to put it on. He's better about it now but I feel so bad putting it on him. It should only be for a short time. We only put it on him when we can't watch him (i.e. sleeping, working).

Gabby has developed an infection at his incision site. He made a trip to the hospital this afternoon. He's back home on anti-biotics and an e-collar. He has to wear it whenever we're not watching him.

I can tell Gabby is yearning to go for his walks again. I took him to the park this morning when I got home from work. He wanted to run. He was pulling on his leash. He's making more use of his injured leg. Poor guy. I'm looking back at his previous post-op pictures and seeing how uncomfortable he was. The swelling has really gone down! Despite everything that's happened, Gabby still loves his walks. What a great trooper!

Gabby's 2 week follow up is not next Monday but next Friday. That's the soonest I could get him in with my schedule. Gabby still has a limp but appears to be making progress. I would say he is walking as well as he did before surgery--he had a limp then too--he had no limp prior to 2/5/05. The swelling continues to go down. I think it's barely noticeable now. He's making more use of his leg too. He can bear weight on it now to lift his good hind leg high and pee. Since he can no longer enjoy walking for miles each day, I've been toting him in the car to his favorite parks as a treat. I just brought him back from the park. It was a short 5 minute. Just long enough to go potty. He was really getting excited though and using his injured leg more than he should have. Gabby hasn't been cooperating with his leg exercises. He's supposed to have 20 three times a day. I manage about 7 before he tries to bite me.

Gabby's sleeping right now. Gabby jumped on the couch again at 7:00am. Gabby seems to be walking better today. We were crating him when he gets excited (especially during dinner time). For the most part he just sleeps in his bed. He's also confined to a room without furniture when we sleep. I've been leaving him uncrated in the house under supervision. Well, no more! It's the crate or the spare room from now on.

This morning Gabby had a relapse. His limp has gotten worse. Cathy says Gabby jumped on the couch this morning after his walk. Gabby is not allowed to jump! We called the hospital and let them know. Gabby's tech said to keep an eye on him the next few days to see if he improves. Gabby was doing so well! Please let everything be okay.

Gabby is due for his 2 week checkup February 28, 2005. I will try to schedule that day to bring Gabby in. I've added a countdown on the top of this page for Gabby's recovery date as well as his 8 week checkup. The hospital says patients with this kind of surgery recover in "3 to 5" months. They expect most dogs to be off restriction in 4 months. I've made June 14, 2005 Gabby's goal of being off medical restrictions. He will be so happy! We can go on long walks again. He can jump and play till his heart's content!

Gabby's doing so much better and acting like everything is normal. Keeping his activities restricted as ordered is going to be challenging. Gabby doesn't like his crate. He whimpers and gets restless when he's crated.

Gabby's pain and swelling is much better today. I wasn't kidding when I said Gabby's leg was swollen 3 times the normal size. I'm surprised the swelling went down so quickly. The swelling is still there but nothing like it was. Gabby was able to walk lightly on his leg today instead of "bunny hopping" with his hind legs. The incision looks good except for some scabbing at the top edge. He's been pretty good about leaving it alone -- only licks it occasionally. Gabby is not cooperating with the ice packs. He's not too keen on his range-of-motion (ROM) exercises either but he's getting them whether he likes them or not. Click on Gabby's picture to see his leg better.

Gabby's leg is very swollen since about the 2nd day after his operation. We've been putting on ice packs like the vet instructed although Gabby doesn't like it. His leg has to be extremely painful due to the swelling. I will be so glad when the swelling goes down. When we picked up Gabby from the vet he had some redness at the incision site. The next day the redness has spread all over his operated leg. Today the redness is gone. I think it was bruising from the swelling. His incision looks very good. He licks at it occasionally and we yell at him when we catch him doing it. Gabby's leg is so painful is is not walking on it for long distances. Instead he "bunny hops" with his back legs. Dogs are lucky they walk on 4 limbs. He's using his good hind leg as a crutch for the operated hind leg. When he's walking short distances, Gabby toe-touches on his operated leg putting very little weight on it. I've included Gabby's care instructions the vet gave to us so you can see what it says.

Gabby pooped on his own! I'm relieved. He had diarrhea then hard stool so he was constipated. The pain patch comes off in 2 days. That should help with the constipation. It was real painful for him trying to poop using that bad leg. He came inside and laid right down in his bed.

I went to work last night and left Gabby at home with my wife Cathy. I had just come through the door when my coworkers said I had a call from my wife and she was quite distraught--something about the dog not getting into his cage. I called Cathy and she said Gabby was upset that I left and was hobbling all over the house. Gabby's on restriction. No unnecessary walking except for going potty. The hospital let me leave to put Gabby back in his crate. When I pulled into my driveway Cathy had already put him in his crate. So I returned to work. What a fiasco!

Gabby's leg is very swollen. It's about 3 times the normal size. The vet has Gabby on a pain patch called Duragesic (fentanyl). It's a strong pain killer which is 50 times stronger than morphine. Although the patch is helping with the pain, it may be constipating Gabby. Gabby hasn't had a bowel movement since the day of his surgery. He had 2 good bowel movements that morning when I dropped him off. I took him to the park this afternoon. I carried him to a nice place to potty then I carried him back to the car. He gets so excited being there that he poops within a few minutes. Gabby hobbled around for 15 minutes but didn't poop. Now I know he's constipated. I'll try a laxative suppository before his walk tonight in hopes he'll poop. Click on the picture so you can see Gabby's leg although you can't see the incision. The pain patch is on his back.

Gabby is home right now. The first thing he did was pee like a race horse in the front yard. He's in a lot of pain and groggy from the pain medication. The second thing he did was lay in his bed and fall asleep. That's all I have time for right now.

Yesterday the vet called at 8:00pm letting us know Gabby's surgery was finished and Gabby was doing fine. I wanted to find out more information but I was too busy at work to ask any question. We called at 10:00am this morning as instructed. Gabby is doing fine and we will pick him up at 3-4pm. I bought him a new crate this morning. He has to be crated for 2 weeks. I'm going to try to get some sleep in the meantime. I have to work tonight. I wish I could stay home with Gabby but my wife will be with him tonight.

The hospital called. Gabby hasn't had his surgery yet. Gabby ate this morning so his O.R. time was pushed back. In the mean time, Gabby had to wait because emergency surgeries were taking place. The vet thinks Gabby will have his surgery at 6:30 pm and will hopefully finish at 9:00pm.

Very anxious. Haven't heard back from the vet yet. I wish he would have given me a O.R. time and length when I dropped off Gabby. The house is quiet. Gabby's bed is empty. I'm getting ready for work. I always walk Gabby before I go to work and he's not here.

Today is Gabby's big surgery. I took him out at 6:00am this morning for a potty walk. He wandered into the neighbors back yard as he often does. He disappeared for a minute then I discovered he was eating bread crumbs the neighbor put out for the birds! No Gabby! No! Your not supposed to eat anything after midnight!

I told the vet what had happened and he rescheduled Gabby's surgery for the afternoon. He's at the vet right now. I'm glad he pottied again right before he went. The vet will call me with the latest news. I'm worried. I hate to put Gabby through all this. He'll have to stay at the hospital overnight too--something Gabby's never had to do before.

I gave Gabby a hair cut. He needed one and I realized Gabby will need 4 months to recover. I don't know when he'll be well enough to have another. I didn't bath him this time. I thought it might be too hard on him with his leg. Haircuts and baths take a lot out of Gabby. I used a vacuum attachment and my wife helped vacuum the hair clippings off of him.

Just to let you know. Gabby is still doing better and running too. I've seen 2 vets since Gabby's injury. Both agree with the emergency veterinarian that Gabby tore his ACL. Unfortunately, the best treatment is surgery. One vet can do one type of surgery the other is a specialist and can do another (more expensive). The more expensive surgery has better results. Gabby is scheduled to have his surgery Monday morning. I don't want to put him through all this but he really loves his walks. I'd like to take him on hiking vacation this spring in Canada. I know he'll love it. I don't think he could handle it without the surgery. Gabby will have a Michigan performed by on Monday. I still don't know what happened and it is my fault for leaving Gabby in the front yard alone. BTW the vet says cockers are prone to this type of injury because the way their leg bones are formed.

Gabby is doing a bit better. I'll hear from the vet that does this type of surgery Friday. No doubt about it, Gabby really hurt himself badly. He's improving. Today he was able to put weight on it several times so he good lift his good leg and pee. :) He tried to jump on the porch ledge this morning and my wife had to stop him. He doesn't seem to care how much it hurts. He still wants to go on long walks and me and Gabby have disagreements about this.

Sorry, it took me some time to write back. I spent 6 hours reformatting my computer and reinstalling all my programs because it kept crashing. My wife finally got to download 580 e-mails yesterday.

Thank you for your thoughts and prayers. Gabby is better today. Yesterday, I was very discouraged watching Gabby limp on his morning walk. He could barely put any weight on it at all and actually hopped with the bad leg tucked in. This morning Gabby is still limping but put more weight on his leg. I see the vet again this week and I'm hoping his knee is not as bad as the emergency vet thought. I think there is a three week time frame that this type of surgery must be done. Anita, how soon did Leroy have his surgery? Does he still limp on that leg?

Yesterday, I left Gabby out in the front yard for 5-10 minutes after our walk--he doesn't want to come in right away. Then when I let him inside I noticed he was limping (right hind leg) rather badly afraid to move and panting away. I took him to the emergency vet and feared the worse thinking he may have been hit by a car with life threatening injuries. While at the vet Gabby made the biggest scene he has ever done acting like a wild animal. They had to muzzle him and he fought like a bucking bronco. The doctor palpated his abdomen and spine and Gabby let out some chilling yelps. Then they took him in the back. Actually, he fought the vet and I had to lead him to the x-ray room. Then I waiting in the exam room while they did x-rays for about 15 minutes. It was a grueling 15 minutes and I feared the worse. Later, the vet came back to the exam room to tell me what he had found. He paused for a minute collecting his thoughts--I felt my heart sink--but said he couldn't find any broken bones or other injuries except he thought Gabby torn his anterior cruciate ligament (ACL). He's not sure how it happened. Gabby is overweight and older which makes him more susceptible for this type of injury.

Gabby might have twisted his knee jumping off the porch which he often does although it's only 1 and a half foot high. Surgery is recommended for a torn ACL but the vet didn't know if this was an option for a 10 year old cocker spaniel. He says he'll leave the x-rays and findings for my vet to see and they'll get a hold of me. Gabby's home on pain medication. This morning he's still limping badly but was excited about taking his walk. Usually I walk him a mile but I shortened it even though Gabby wanted to walk further. Poor boy, tried to lift his good hind leg to pee but couldn't because of the bad hind leg.

In the meantime, I've been downing anti-acids to deal with the stress. Everyone please wish Gabby good luck.

*If you are not currently a member of My Cocker Spaniel please mention Gabby's journal when you apply.

Gabby's Surgery & Recovery Journal

Chronology of Events