Wednesday, July 24, 2013

All is well!

I am soooooo far behind on updating my blog regarding Vegas and her roller coaster of health issues. It's going to have to be the Cliff's Notes version for tonight with a few summer pictures thrown in for good measure and I'll detail out what happened at a later date. AND try to keep up with this as I find writing cathartic and I want the history of my girl documented.

Day of Surgery 
We arrived at the surgical center bright and early and Vegas cranky with no breakfast. Seriously. Unhappy girl. We went in and took care of paperwork, had blood drawn for pre-surg labs, and then hung out in the waiting room. A while later they took her back for her pre-op exam and then returned her. Someone came out shortly and gave pre-meds. We hung out a while longer....long enough so that I went and got her crate pad to lay on. Chilling and chilling and chilling until finally, a couple hours later they wanted her back for the full anesthesia.

Here are her pre-surgical labs:

About thirty minutes later Dr. Munjar came and got me. Oddly, I thought, he came through the exam room. He had x-rays to show me. Low and behold he no longer thought we were dealing with an ACL tear. Prior to coming out to talk to me he had gone ahead and had the techs take hip films too, but they also looked great. So after we talked and he sort of scratched his head and puzzled a moment he went and asked them to take a spinal/back film.

Here are the knee films taken on the day of surgery, June 5:

Remember, the left is the one we were supposed to operate on. Basically he just didn't think it was ACL any more because the signs were not there on the x-rays. He said there is no way a dog of her size could favor the leg enough to take the weight off and not have scar tissue building up where the ACL connects to the knee. In fact, if he didn't have L(eft) and R(ight) indicators on the films, he might have speculated the right was of issue, if anything. Regardless, he was completely straight with me and said that we could do the surgery but his suspicion is that what was bugging her would still be there six to eight weeks post-op. The options prior to looking at the back film were: 1) Send her to another specialty facility with an MRI and see if we could get a better look inside her knee; 2) Go ahead with surgery, make a smaller incision and see if he could scope the ACL and see if it was really torn; or 3) Proceed with the surgery and hope for the best.

He's an honest kind of doctor and experienced enough with these surgeries (He has done hundreds if not thousands!) that he just wasn't feeling it.

Here's her hip rads; not too shabby for a 6.5 year old girl from a first breeding of young parents. :)
Here is the spinal x-ray:
So upon seeing this he figured that was our answer - at least enough to pursue it before an ACL. I've included another version of the spinal rad below with markup to show what was notable:
Basically her spine was growing a bit of extra bone underneath the vertebrae. Being an orthopedist, he felt our best bet was to go see a neurologist for more workup and opinion. That's what we decided to do and I got the referral to see Dr. Peterson at Cascade Veterinary Referral Center.

After the doctor and I were done talking I went outside and had a good cry. The whole turn of events took me completely for surprise and I just lost it emotionally. After all, we've been through so much and the surgery was at least our solution. Now we had more questions than answers and possibly more expense on top of potentially coming back to this surgery. I paced in the grass alongside an empty/vacant building, cried, tried to get myself under control, and cried some more. Finally I spied one of the techs who had come out to get me, pulled myself together, and went in with her. The poor receptionist was worried and asking if I was okay; she didn't know what Dr. Munjar and I had discussed yet.

I followed the tech back and sat with Vegas as she woke up. It took quite a while and boy was my girl drunk. Sloppy, dry tongue hanging out of her mouth, wobbly, and whiny. Whew. An hour or so later she was finally awake and we had paid, gotten our meds, and gotten loaded for the trip home.

All said and done I guess we spent about five and a half hours at the clinic that day plus commute before making it back home to cuddle on the couch. I called Dr. Peterson right away to make the appointment and they had openings for that day or the following. Upon Dr. Munjar's suggestion, I needed to wait at least until the next week for the discomfort to wear off from being manipulated under anesthesia for the x-rays to dissipate and the pain meds we had been prescribed to wear off. We ended up scheduled two weeks out.

Neurology Appointment, June 19
Her appointment was in the afternoon. I rushed home from work, pottied the dogs and Vegas and I hit the road. Traffic, of course, slowed us down drastically and we barely made it, having to call them and let them know we would be a few minutes late.

The first thing I have to say is, Dr. Peterson and her tech, Chris, were incredible. INCREDIBLE. I spent a long, Loooooooonnnnnnng time explaining all of her symptoms and the history to Chris. He was patient, asked clarifying questions, and documented it ALL. It was wonderful. In many ways I needed to tell it all to feel like the history would be considered. Cause honestly, Vegas has acted completely fine and normal since April when we released her from the kennel and started playing and being mobile again. She only had a little "hitch" in her walk on the left rear. Historically this has been there for years. Not sure why after the "launch off the bed/limping" incident early February I didn't pair the two together. So anyway, Chris listened and documented and then did his preliminary stuff - heart, lungs, temperature. Then he left and Vegas and I hung out for ten minutes or so. Then Dr. Peterson and Chris came in. She asked more questions and then started doing a physical exam on Vegas. I was able to explain my concerns about putting her down on the floor (side or back) because of what happened at CVC with Dr. Bullard.

They completely, 100% understood and being a neurologist knew the implications of forcing a giant dog who was scared into a down or onto the side. Instead we talked Vegas into a down (on her belly) herself, then spent the time petting her and talking to her to relax a bit more. Chris could then bear hug her while I pet her and just sort of leaned down and she went with him. It was really cool that she cooperated as the act of being restrained sometimes only freaks her out as she is concerned someone will take her from her mama. Regardless, their patient method worked and I'm ever so grateful.

So Vegas down Dr. Peterson proceeded with her neuro exam. She manipulated her feet, used the reflex hammer to check responses in multiple areas, etc. I don't honestly remember all or even most of it. Then she was able to get up and we repeated the process for the other side. Afterward she checked her head and then we turned out the lights to check her eyes. The last step was to go outside. She tested her neurologic responses by turning her toes under and waiting for her to "reflexively" turn them back the way they belong. It was interesting and took a while because Vegas wasn't consistent in her responses for a while and actually, I believe she was comfortable enough with them at that point that she was just complacent with what they were doing since it didn't hurt or scare her.

After that test I gaited her and gaited her and jogged her and walked her slowly and repeat over and over. They were watching her walk, looking for any dragging toes, and to look for that "hitch" I mentioned she's had.

The findings: Dr. Peterson felt she had a mild but consistent delay to "UN" toe under on the right rear - meaning when she turned the toes under and set Vegas' foot down, she didn't immediately flip her toes up to stand correctly on the pads. She figured the slight hitch I was seeing was possibly the tiniest of swings with her foot - basically instead of picking it up and moving it forward she was bringing it ever so slightly outward (away from her body) before setting it down, thus causing a hiccup in her gait. Crazy the things I notice I tell you.

The x-rays were insignificant. She said the bridging occurring is so incredibly normal and common. She said any large or giant dog is likely to develop it at some point and most of it is harmless. She sees it all the time in active middle-sized dogs like Labs. I asked about taking more x-rays to see higher up and to see the lower portion more. She said we could but doubted it would give us any more information than the current x-ray. Basically, the signs Vegas was having don't necessarily have anything to do with the bridging and there wouldn't necessarily be anything to do anyway. So basically, believe it or not, we got the go ahead to resume activity and have a life again. She didn't see the reason for any more workup or to restrict her since these random and minor clinical signs don't point to a real problem. So hooray for awesome news! We could work on having a life again and I could begin to build her back up!

The only caveat to the visit was the minor bomb dropped on me in regard to the pre-surgical bloodwork done on June 5. I'd not seen it nor known the results. Apparently the red blood cell counts were elevated - enough so they stuck out to Dr. Peterson. We discussed those results and I decided it was worth it to follow-up with new labs just in case. I don't have the constitution to "wait and see." My mind wanders in too many directions and I would have been focused on that instead of starting to get out and enjoy summer with my girl. We drew the blood and then headed out for a potty sample too since kidney function could be related if there was something going on. Vegas cooperated and we were off and headed home.

Follow-Up Lab Results
We had results in almost no time. They'd been sent out to a veterinary lab and upon receipt of the results Dr. Peterson called me. Here they are:
The good news, the original issue - red blood cells - was normal. In other news, her urine showed blood in it yet we obtained it via free catch (She didn't have to have a needle inserted through her side into her bladder to take the sample - AKA cysto.) and didn't note blood visually or by color.

All in all, Dr. Peterson wasn't too worried and again, kind of figured the wait and see approach was fine. I ran the results by a veterinarian friend and a tech friend and opted to instead do a follow-up UI. To date we haven't done that yet as when I took her to the vet two weekends ago she wasn't as cooperative with her "Go potty" on command behavior. I'll update regarding that visit in a few days.

In the meantime, we've gotten back to "normal." We walk as often as possible and are practicing obedience in the front yard. Here are a few random pictures to cover the last month or so.
Raw bones in the sunshine
Back scratches in the sunshine
Crazy dog recall at the park.
Lovin' the hedgehog
Does this pool make my head look fat?