The true start of his rehab 9/6/2010

So I have started doing his advanced exercises along with his walks but it's going slow. I think Guinness is going to need some practice is all, and me too I'm a little rusty trying to remember how to do them properly. Guinness does well on his walks, as long as he doesn't get too excited or want to run (he'lll start to hop and carry the leg). I have to encorporate hills into the walk which he is doing well with, If I go real slow he keeps his left leg down the whole time. Cookies at Contra-lateral hip-he tends to lift his leg or throw out his back to try and compensate, so he can't do this one properly just yet. The three leg standing, I need a refresher, I feel like no matter what I do he's bearing weight through my hand. I will ask the rehab therapist at his next visit for some tips. Paws up- he is doing better than the first time after surgery but doesn't always keep the left leg down, he intermittently stands on it bearing weight. With more practice I know he'll get it.



A website I found shortly after his first surgery, topdoghealth.com, is full of information for dog recovery and rehab. I found them through a video on youtube.com. They actuallly have step by step manuals (Home Rehab Guides) that take you through recovery for certain orthopedic procedures, i.e. FHO, MPL, THR, etc. for sale. I found http://www.fhoguide.com/ by accident, which gave me there FHO Home Rehab Guide for free. It repeats everything that VOSM has in there discharge instructions but has a little extra.

Written instructions aren't as good to me as a video and the topdoghealth website have a few which has helped. They just added a few more recently, one being for Cavaletti poles- http://http//topdoghealth.com/infusionsoft/videos/Cavaletti-Poles.html and http://http//topdoghealth.com/infusionsoft/videos/Figure-8.html. Cavaletti poles are poles placed at different heights for dogs to walk over. They are also used in agility training but most commonly people have seen these poles at horse shows, where the horse is jumping over them. I wanted to make my own and try it out but safety cones I found at Home Depot and Dicks Sporting Goods are $10 a peice and I need atleast 4. I don't want to pay that much so I looked at a few other places but they were too small (Party City and Sports Authority). I was thinking about using milk jugs and feeling them with sand or rice (too light on there own) but then when I went to the grocery store this afternoon they had $1 small laundry baskets which was perfect and I don't have to drill holes, it already has them :). The baskets aren't as cute as the cones but O well it works for me. I took Guinness outside tonight and tried them out. He did pretty well. One exercise is to do figure 8's- which helps work different muscle groups than straight walking does, helping with balance and proprioception (dog's ability to know what orientation his legs and paws are in). The other exercise is to have your dog walk slowly over the poles which helps to increase strength in his legs and balance. Guinness did pretty good I think, he is a quick learner. I'll ask the rehab therapist if I should continue with the Cavaletti poles but I'm sure she will encourage any effort to get Guinness to use his leg. I probably need to buy some more too.

Cavaletti Poles



Figure 8's

9 days post FHO surgery 9/2/2010

So by a 3-4 days post op Guinness began putting his left leg down intermittently then by a week he has been walking on it intermittently. I'm glad to see that he is walking on it already. I'm keeping up his ROM exercises, he does ok with them. Sometimes it doesn't seem to bother him, especially if he has a treat or toy he is interested in but others times he starts whinning from the start.

Meds: The first 3 days he was on 3/4 tablet (pain med) 3 times a day for pain, he was pretty whinny. Then by day 4 I gave him 1/2 tablet 3 times a day and by day 5 to now he gets 1/2 tab twice a day and seems to be doing well on it. He is still taking his rimadyl and antibiotic. His rash has gotten so much better, its barely visible now.

His first follow up visit is tomorrow, friday. His staples are scheduled to come out. His incision looks really good and is healing well. He also starts his rehab too, the ROM excercises and heat therapy with the rehab therapist. Week 4 he starts his water therapy hopefully. Starting tomorrow I can begin his slow 5 minute walks, I did a mini one today and he did really well. He is beginning to walk on it alot more now. It's amazing to me that he is using his leg alot quicker this time around than with the first surgery. But that is what is expected for this surgery, so yea his recovery is going as expected this time around.

Round 2: HIp Surgery 8/26/10

Guinness had surgery on his left hip 8/25/2010. The procedure he had is called FHO (Femoral Head and Neck Ostectomy). He is not a candidate for hip replacement (see previous post) so he had to have this one done.

FYI: When an FHO is performed, the ball and neck portion of the hip joint are removed. After the procedure, a false or fibrous joint will form between the pieces of remaining bone. This joint is not anatomically normal, but since there is no longer any bone on bone contact, the pain associated with the arthritis is generally relieved. As long postoperative use of the leg is good and physical therapy is performed, the use of the limb and range of motion can be relatively good. This procedure is very effective and successful in smaller dogs and cats.If there is poor use of the limb after the FHO and physical therapy has been unsuccessful, there is generally little that can be done to improve the outcome.

The tech explained that Rehab will be extremely important this time around. The quicker he is weight bearing the better because as he walks and uses the limb he will form more and more scar tissue which will strengthen the joint. I really hope he starts bearing weight on it soon and I will be even more diligent (if that's possible-I worked pretty dang hard last time) about getting him moving. She said its normal for him not to bear weight on it for a few days but should by 7 days intermittently.

This time around we start his underwater treadmill therapy 2 weeks earlier at 4 weeks vs. 6 weeks. We didnt even get to try it with his last surgery, watertherapy was week 6 and by week 4 Dr. Lotsikas changed his plan of care and discontinued the rehab therapy. I think Guinness will like the water treadmill therapy, he loves the water and will walk on all 4's when outside for walks after his first surgery. Holly, the tech, explained he would most likely do so because he was distracted, once in the house there weren't as many distractions so he would carry the limb instead.

So Guinness had surgery yesterday and got to come home yesterday. He is more whinny this time around but after giving him his pain medication and going out to pee and poop he settled down for a nice long nap. I feel so bad for him to have to go through this again, he has been through alot at such a young age. He will be 11 months old on August 30th, time has flown.

I start his ROM excercises Saturday.

I made him another Post Op Recovery Routine sheet so I can keep up with his meds and rehab. It really did help to keep me on track last time and accountable to do his exercises.

4th week appointment 7/29/2010

So Guinness had his 4th week appointment today, I'm so glad Doug could come because I think I would have lost it without him for the news...Guinness has to have surgery again, this time to fix the hip dysplacia on his left leg. :(

The 4th week check is rehab plus repeat xrays to make sure the knee is healing. Dr. Lotsikas met with us and told us his knee looks great on xrays, it is healing well. Usually by week one after MPL surgery, dogs will start to bear weight on their surgical leg and by week 2-3 will walk mostly on it, Guinness has not. The xrays did reveal that Guinness' left hip has gotten worse, and has come more out of the socket. This is most likely the reason he isn't wanting to walk on it much.

He reminded us that with the first surgery we(Doug and I, my reg. vet, and him) were going back and forth with whether or not we should do the knee surgery vs. the hip surgery first, knowing that either way he may need both procedures done long term. He and his colleague made the decision that the knee should be done first and may or may not need hip surgery later on in the years to come. It's evident with today's xrays that he will need hip surgery. He said hindsight is 20/20 but admitted that it might have been better to do the hip surgery first but either way he would need both done. He was very sincere in apologizing to us that Guinness isn't recovering like we all had hoped. We had discussed (before the MPL surgery) doing both at the same time but is a much harder recovery for dogs and a better option is to split the surgeries for a better longterm recovery and result.


He spoke with a another orthopedic vet (that's in Ohio- he flies him out he said for hip replacement surgery's to assist) about Guinness' case today over the phone and they looked at measurements for a possible hip replacement. Unfortunately the measurements of his hip socket and femur head aren't likely to have a successful outcome they concluded, thus Guinness would have to have the FHO procedure that we (Doug and I) thought he would need in the first place.

I'm not mad at VOSM just upset that we haven't had the outcome we were looking for and now have to look at more surgery and more rehab(12 weeks this time-even longer). And I'm devastated for Guinness that he will have to go through this all over again, and unfortunately much longer this time. Dr. Lotsikas was very sincerely sorry that this has happened and stated that he wouldn't charge us the usual FHO procedure ($2400) but what it would have cost to do both the MPL and FHO together ($800-1000).

I'm just so beside myself. :( I was so looking forward to getting him back with our puppy group in a few weeks for some last enjoyment of the summer. Now I'm looking at having to do another surgery, restarting his rehab/exercises routine all over again (it's been hard enough getting him to this point)and a much longer recovery this time. In the meantime Doug and I have vacation Aug. 13th-21st (I so need it) and Doug has foot surgery September 13th and will be in a cast for 6 weeks. I will have to plan his Guinness'surgery after Aug. 21st but of course Doug and his recovery will overlap and I will have to nurse both of them back to health. I'm so not looking forward to September it's gonna be rough, I so need to book some massage sessions now. :)

Awaiting 4th week appointment 7/27/2010

Well despite taking the Robaxin now for a whole week (and back on Tramadol-pain med. twice daily) I don't see any change in Guinness. He still only bears weight on his left leg when we go on slow walks. Even during the walks he walks very guarded with it an if he walks to fast he starts to hold it up again, it's hard to get him to walk slow sometimes he has so much pint up energy. No more luck with the new excercises he still won't bear weight on it and now Doug and I are getting worried. At 2 weeks they said he would beging putting weight on it and walking on it mostly by 3 weeks. He is not doing well in his recovery. :(

He has his 4th week appointment this Friday. I tried calling yesterday to see if they could squeeze me in yesterday but they were booked. They did offer to change the appointment to Thursday at 8am so I did, hopefully Doug can make it too and just go into work a little later. He has his rehab at this appointment and repeat x-rays. I pray everything healed correctly and we just need work with him more. But what we are doing obviously isn't working. I wonder if they will let him start his water therapy early, he isn't supposed to start it until 6 weeks. I think he is still fearful to bear weight on it and then holding it up has become habit for him. I wonder if they will atleast clear him to go swimming. I think that would help build back the muscle strength in his left leg, it has atrophied so much in comparison to the right rear leg which has hypertrophed. Which is to be expected with a leg injury but a couple of weeks post surgery he should start to rebuild it back by bearing weight but he isn't doing it. I just keep praying that we will find an answer on Thursday.

I'm just at a loss and hope that he gets better. I've missed taking him on walks, going swimming, and hanging out with our puppy group so much, I know he misses it too.

3 week appointment 7/20/2010

Despite doing his new excercises we have been having a hard time getting Guinness to put weight on his left leg, he will do it with slow walks only, but not when he comes back into the house walking around. We had his 3 week appointment today-laser therapy.


I told the rehab therapist that Guinness doesn't do his excercises properly and bears weight on the left leg only with slow walks. She started doing ROM exercises on him and when she fully extended his leg back he growled at her some. She rubbbed on his groin muscle and he growled again, she concluded from this that he probably pulled it somehow. She put him on a prescription for Robaxin, a muscle relaxer to be given twice a day. She also said to restrict his activity for the next 2-3 days and refrain from doing his new exercises until then.

So, a little set back that's prob. our fault. He was probably been doing too much and that's what caused him pulling his groin muscle. At first we were restricting him to his room and if let out of his little room we leashed him to nearby furniture with us when we could watch him, prob up until week 2. We have since become more lenient and with him and not putting the leash on indoors, so he has been able to walk/run (I'll confess) downstairs in the basement--we started letting him off leash because of his whining due to confinement. But excuses aside his 2nd week instructions states "No off leash exercise, no running, jumping, or playing until surgery site is healed (approx. 12 weeks). "

It is extremely difficult to keep a 9 month old puppy confined. When alone (if I confine him to his little room) he whines excessively, eventually (prob. 30 min. or more) tires out and stops for awhile. I try to spend time with him through out the day....bring him in our comp. room, door closed and play with his toys while he is laying down but of course he wants to get up and walk around, and I have to correct him. After 10 minutes of this he whines some, I'm sure because he is tired of being restricted and wants to do more. This is hard for both of us. And because I'm spending so much extra time trying to keep him occupied, I'm not getting much done around the house. I haven't found a good balance yet.

I'm still giving him the calming pills although I don't think they are working too well, but he does sleep a good bit during the day since he has been taking them. I've started the Robaxin as ordered and put him back on the Tramadol for pain.

First Walk 07/15/2010

I took Guinness out for his first 5 minute walk today and I couldn't believe he put his left leg down finally. If I go real slow he can manage to walk on it some but bunny hops if you go to fast. Of course, he wants to run so I have to really work at slowing him down. I attached a video of his accomplishment :P

The excercises are really tough, I have a hard time getting him to them properly, he is still fearful to put his left leg down. Doug and I will def. need to do them together. He has his second rehab visit next week so I hope he is doing better by then or I might have to ask them for some suggestions.