Under The Knife
After being saved from a hoarding situation, welcomed into the 2H4P Foundation, and being diagnosed with bilateral patellar subluxation AND Ehlers-Danlos syndrome (EDS), Matilda was ready to get to work. The goal was to get her wonky legs repaired and her EDS under control to the point that she could live a pain-free life and hopefully find a forever home.
Matilda’s first stop was Animal Specialty and Emergency Clinic, one of the many outstanding surgical centers in the Los Angeles area. She was going to need two surgeries spaced a few months apart. Matilda’s surgeon, Dr. C, elected to operate on the worst knee first. His reasoning was, “Why put her though surgery on the other, less-bad knee only to find that surgery on the worst knee would not be successful?” We agreed and on December 28, in her left stifle (knee), a modified wedge recession trochleoplasty was performed, deepening the groove beneath the patella. A tibial tuberosity transposition was then performed, shifting the bony point of attachment of the patellar tendon to pull the patella into a straight alignment. Stainless steel bone pins were placed to stabilize this area as the bone healed. The adjacent ligamentous tissues were sutured to achieve good stability.
Matilda was discharged from the hospital with instructions to return on January 11 for suture removal. February 8 was scheduled for postoperative x-rays and to quickly (same day) move on to the surgery of her other stifle. Her discharge instructions mentioned that moderate bruising and swelling of the surgical site, and of the lower portion of the leg, is typical during the first week after surgery. This was a serious procedure. It was also important that the Elizabethan collar be kept on 24 hours a day, until the sutures were removed. This was to prevent licking the incision site. Many dogs carry resistant bacterial organisms in their oral and nasal cavities, and even a brief moment of licking at the incision could introduce bacteria to the surgical site, greatly increasing the risk of infection. That would be really bad.
We got a kick out of the note about the healing period. It was expected to be eight to twelve weeks. We get that. It’s normal. But they also said, “Most patients will carry the leg for the first 1 to 2 weeks.” Carry? With what? The other leg is no good, either!
We gathered up her antibiotics, said goodbye to Dr. C and his staff, and headed out. We had her pain meds and Chinese herbs at our clinic. We got to work helping the surgically repaired stifle heal as quickly as possible. She had sutures, so that meant no hydrotherapy. But there were lots of other things we could do, like gentle massage with Passive Range of Motion (PROM), laser of both stifles to reduce pain and inflammation, an Assisi loop to accelerate the repair process, and of course ice for swelling and pain relief. Acupuncture for dogs (and cats) is an important part of our services and for Matilda it was especially so.
On January 11 we presented back at the hospital and everything was good, or so we thought. Here things got a little hectic. It turns out that one of the pins in her knee had migrated, causing a suture to fail. This is not uncommon given how serious the luxation was on this knee. The good news was that that was the extent of the problems. So Dr. C. further stabilized the patella by tightening the medial (the side of the knee facing inwards, towards the other knee) tissues and placing what is known as a medial patella-fabella suture. Did we mention that Dr. C. is board-certified in surgery? He is. After having taken care of the left stifle Dr. C. came out to see us and suggested that he advance the schedule for the right stifle surgery to…now. Like, right away as she’s still sedated. She wasn’t going to be able to fully recover and (hopefully) walk until both knees were fixed so let’s just do it now. He had the confidence that we’d be able to care for her during her recovery and she could avoid more weeks of pain as she waited for surgery No. 2. We said, “Yes!” and Dr. C. disappeared back into the surgery room. We love him.
The second surgery was a relative piece of cake, with the modified wedge recession trochleoplasty and the rest. Matilda spent one night in the hospital and was retrieved the next morning by our Practice Manager. What a homecoming it was. Our animal acupuncture and rehab center was positively buzzing! Big smiles and happy tears all around. Had Matilda even been loved so much in her life? It’s hard to imagine. She was our little warrior.
But warriors stay warriors only by doing the work. Matilda had a lot of work ahead of her. For one, she had no strength in her legs. She had never used them. She couldn’t fully extend her legs because she had never been able to. She used to be hunched and scrabbling around and now we were asking her stand up straight and walk like a “normal” dog. And run? Forget it. Her back was painful. Her neck was painful. She had sutures. She had swelling. We had work to do.