Rehab Day 2

Well so far the new combination of tramadol and carprofen twice daily seems to be helping more then anything else. Bedtime saw Kenz have no issue racing upstairs last night. Similarly another first in many many months - Kenz happily jumped on my bed first thing in the morning.

We tried another session of her reverse 2o2o and she is nailing that and we just keep adding height with each session :). Its easy enough to see when its obviously hurting and she has done enough and trying to remember to keep things short and not do much is always my biggest short coming with training.

Unfortunately both walks today have been a little bit of a disaster. She really struggled. Poor little girl something obviously hurts so very very much. I wish I could be 100% certain its her patella coming out but its not quite that straight forward.

Starting to wonder if I should cut the walks completely but not sure since she is otherwise so feral with so much energy to burn. Hmmm more thinking to do I suspect. 

A rehab plan and a conversation via FaceTime

Yesterday I decided to message one of the canine rehab people in the states who also happens to work out of a specialist centre and has posted some canine rehab videos to youtube which I have come across in my quest to find information to help Kenz. A guy by the name of Robby Porter with SuperPan the BC.

He very kindly offered a real time video chat to go through some of what I had mentioned and suggest a few things which may be of assistance to Kenz's recovery.

He discussed what the general view is on patella luxations and that grade 2 normally does require surgery. He was a little surprised that no x-rays had been taken. We went over Kenz's lameness/soreness history and he mentioned the possibility of an iliopsoas strain which would be consistent with some of the symptoms Kenz is experiencing and not out of the expected with her history of issues in the last 2 years. He also mentioned it wasn't especially easy to diagnose and lots of specialists miss it.

The comment on the meds was that as they are helping there is clearly more then just mechanical lameness in place. He also said that while she was on the meds was a perfect time to start the rehab exercises.

We had a chat about assessing exercise and the core factors to consider during planning rehab of speed/duration/frequency. The comment was to look at how she is the following day and make an assessment as to whether I can add more or whether I need to reduce it.

The comment was if at any stage in recovery a dog is not improving weekly then there is something wrong and it needs to be considered further.  He also commented that she should have been fully back to normal at 6 months post-op.

On the area of rehab apparently swimming is not especially good in rehabbing stifle issues and walking through shallow water is really only useful if its below the stifle.

The suggested exercise were: treadmill tricks which can be used to elongate the quads/a reverse 2o/2o, squats with and without props to increase the range of motion required and the Sylvia Trckman hide trick.

Kenz started this afternoon with the reverse 2o/2o trick of which the video is posted below.

Tonight I am eternally grateful for the generosity of his help and at least I feel as I can take some control over the situation. He has also volunteered he is happy for another conversation in a couple of weeks time if I wish.

Another evening from hell......

After more emails with John - Kenz started on a combination of carprofen and tramadol twice daily on Tuesday evening.

Tuesday evening we had a definite what I think was patella slipping type episode.  I had my hand on her LH knee while I was putting a cool coat on her and I actually think I felt it move. A little strange as I don't think she was actually "doing anything" at the time however I felt something move which didn't appear normal.

My more worrying concern is what happened yesterday.

Kenz had a really nasty collapse type episode at the park yesterday evening which doesn't even fit her normal BC collapse episodes. It wasn't warm. She had been running around fine prior to it happening maybe 5 minutes or so. All seemed fine she hadn't slowed up/started having a purple tongue or showing any signs that she wasn't coping.

I had been keeping an eye on Ness only to turn around and see Kenz with a fairly significant head tilt and then she went wobbly and crashed.

My first assumption was it was just the "usual" for her and went to grab Ness and leash her so I could carry Kenz home. Normally Kenz tries to get up and take a few rather wobbly steps towards me and will then lay down panting again mostly with her head up.  She was flat on her side and didn't even lift her head.

I carried her home went through the usual post-collapse regime which means I cooled her off, forced her to drink fluids and then she basically lay completely on her side on the slate for a good 40 min. Her usual length of recovery is significantly shorter more like 20 minutes. Normally she would be fully recovered with no residual lameness or soreness.

Interestingly she did manage to walk up the stairs last night so the combination of tramadol and carprofen is working better so far then the 20mg of carprofen alone or the tramadol. Previously even on the carprofen alone I had resorted to carrying her up in the evening.

Kenz had been asleep for about an hour and then my brother came home and she obviously woke up and desperately wanted to go and greet him. She wasn't able to walk down the stairs and when I let the girls out for a toilet break before bringing them back up she was significantly more sore and stiff since then when the shoulder was treated. Not only definite front end soreness/lameness but her back end seemed seriously problematic.

She certainly was a little worse for wear considering she actually hasn't done a huge amount yesterday.

Any way this morning she was super lethargic and wasn't super keen when I took them out this morning mostly she is sleeping a lot and had a seriously bad upset tummy. She still seems to have a reasonable appetite though.

Based on all of this and the fact we are in for a 4 day long weekend I sent an email off to John who responded that he had forwarded it to Ian. So now I am desperately awaiting Ian's response and a little unsure as to whether I should continue the pain meds. I did give her her usual meds tonight and she had no issues with the stairs and raced straight up.

A little more happened today of importance but I will save that for a second blog post.

After a horror week, a day of positives

Kenz started back on full dose carprofen on Monday after John got back to me regarding the outcome of having her on tramadol.

The agreement was to put her back on the maximum dosage till she was comfortable and then try and reduce the dosage incrementally again. Since originally she had 4 days at max dose that was what I decided to go with again this time around.

I won't say the week has been hassle free and easy. Its been tough going up until today. The usual club training round on Tuesday night saw Kenz battling with BCC. She managed to get through the exercises but was progressively losing focus and when I took her out the ring I saw her tongue was horrid shade of purple which is one of the precursors to a collapse episode.

The rest of the week has also been a bit of a struggle. Her apparent reduced threshold to collapse has meant a number of times we have all but managed 5 minutes at the park and even that seems like 5 minutes to long on occasion. She has also still been having huge lameness issues when I have so much as attempted a leash walk.

Today however was maybe a sign of better things. I took her back to the dog pool for a swim knowing its the only exercise she can have that I can relax over.

Well didn't she have an absolute blast. Comfortably managed 40 min with a lot of swimming in that time. Soooo nice to see my baby girl enjoying herself. I was a little hesitant when I saw her not putting 100% weight on her LH on the way back to the car and thought what is going to be around the corner.

However its now bedtime and I needn't have worried. She has since managed 2 feral walks to the oval and a training session in the yard, not to mention racing up and down the stairs on a whim. She even managed to come up the stairs at bedtime albeit with a lot of encouragement.

The other huge positive for the day is I also managed to cut off half a carprofen tablet from each dose without her looking any worse for it. Small steps forward. Down from 60mgs a day to 40mgs a day.

Now I just have to cross my fingers that the cooler weather sees a reduction in the frequency of the BCC episodes and also hope I can continue to reduce the NSAID dosage and she continues to remain as comfortable as she is currently.

The 4 day tramadol trial

Well I am not going to say the situation is great its just not. She is almost certainly worse on the tramadol then she was on the anti-inflams :(. One night she has needed carrying upstairs because she hasn't been able to walk, the most she can manage is a quick 15 min walk around the block and even that is a struggle and we have to stop.

She is spending a lot of time in her crate dead to the world and that really sucks.

We had some quite significant RH lameness so I can only presume the patella situation is deteriorating :(. Its a bit of a catch 22 if she won't exercise she will continue to lose muscle and the patella situation will continue to worsen.

Another day on just tramadol and then we shall see what John wants to try next :(.

The experiment - phase 2

Given my lack of success with reducing Kenz's dosage of NSAIDs and her remaining comfortable John has now recommended trying the tramadol to see if that has a similar effect. Apparently that is a better alternative for longer term pain relief then the NSAIDs. So I guess we go through a few days of that and seeing how she gets on.

So over this - my poor baby girl would rather be back running around and happy and instead its just a bit of a mess.

So the saga continues..........

So its been a week since my last post on the anti-inflam experiment. Kenz has remained on anti-inflams and John was back in touch later in the week to suggest trying to reduce the dosage. He still thinks the patella is part of the problem because if it was purely discomfort then she would be 100% while on the pain meds. At the moment Kenz is back to just one dose of 30mg carprofen once a day and I am suppose to keep reducing it as long as she is no worse.  I am also suppose to be trying to work out when she is lame if its because of the patella so its vet 101 for me.

I have tried to get Kenz to the beach as much as possible over this last week. Swimming and walking through shallow water are all good activities to try and improve the status of the luxation. Its been to hot for much else.

Unfortunately she has had a very rough time with 3 EIC episodes within 24 hours earlier in the week. Seriously frightening. On at least one of the occasions she was completely unable to stand :(.

A lot of soul searching and wondering whether its worth keeping her around or whether the kinder thing is to have her put to sleep.

At least the anti-inflams seem to be helping and she is continuing to manage more exercise then she had otherwise been managing.

We are messing around with the Rally stations and having a small amount of fun with some limited training. Have to be super careful with her though. Mega short sessions, lots of access to water and forcing her to drink to try and avoid her running in to issues.

The not so good news is that after happily coming upstairs last night when she hadn't had her evening dose, tonight she stopped at the bottom and wouldn't come up for anything in the world.

I do no differently so I can only presume its pain related. So frustrating. I guess this means she is back on the max dose until I can speak to John about where to go with things now :(.

The 4 day anti-inflam experiment

After some discussion John and I agreed it was worth putting Kenz on pain relief and seeing how she did.

She was to try 30mg carprofen twice a day for 4 days and to see how she got on.

Well after nearly 4 days on anti-inflams the observations I have for Kenz seem to mirror those from last time when she ended up on anti-inflams at the end of last year.

The improvements generally:

• Within 24 hours the stair issue in the evening had resolved;
• Increased willingness to use the stairs of her own free will across the remainder of the day with no apparent hesitation;
• Generally seems much happier and more enthusiastic;
• Coping with more free running exercise eg managing more time at the beach/oval and not increasingly sore either during exercise or post-rest;
• Less struggle pushing off with her LH while training; and
• Not quite as lame or sore or struggling on every leash walk.

So things have definitely improved over the 4 days. She had a couple of hind end lameness issues (in both the LH and RH) on Thursday but since then she has only seemed to improve still further. She did need carrying up the stairs on night 3 but I appreciate there may also be a mental component in that behaviour (although incidentally it was the same the first time she was on anti-inflams) and I also did swim her rather than just walk her that day so she did more.

What is still a problem for her:

• There is still issues with reluctance to place full weight on the LH – more noticeably when she is standing and more an issue when she is being leash walked compared to free running. While she is tolerating more exercise I am still having issues with leash walks greater then 10-15 min. Whatever is bothering her is not a problem that seems to resolve within a few steps so not sure that would fit with it being the residual luxation; and 
• When working on obedience there is some definite shifting weight off that LH when asked to sit. She usually sits very balanced but isn't these days.

So that is where we are at based on the addition of anti-inflams. John also prescribed tramadol to have when she got really bad but so far I haven't resorted to needing that.

She had an absolute blast this morning at the beach and managed a more then respectable 50 min trip before I took her home again. At no stage was she standing on the shore waiting to go home.

When I ran all this past Matthew he still felt the plan should be to go in and remove that suture as its obviously causing discomfort. I am waiting to see what John has to say before I make any further decisions about what I do.

In the meantime here is a short clip of Kenz doing some training in the yard yesterday afternoon.