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.

2 week check 7/14/10

Guinness had his 2 week check on Monday, I had to work but Doug went for his appointment.

His incision is healed, yea no more cone collar! He had his first rehab session-laser therapy to help stimulate healing and provide pain relief. The rehab therapist said its evident that we have been doing his ROM exercises because he is very flexible with both back legs, kudos to us! :) He is still not bearing any weight on his left leg, only intermittently putting it down at times, she would like to see him putting more weight on it but the new set of exercises for us to do may help. He is holding alot of tension in his unaffected limps and back, obviously due to not bearing weight on his left leg, she said that was to be expected.

I wish I could have been there for his first session but Doug said the ladies baby'd him and praised him all through out in baby talk (like we woman do, hehe), gave him kisses, and said he was such a sweet boy. So as long as he was loved on, I'm happy!

I had to work Tuesday too so I haven't really had a chance to do his exercises until this morning (Wed). The new exercises are to help encourage Guinness to bear weight on his left leg. Doug said these are harder than his ROM exercises b/c Guinness still doesn't bear want to bear weight on his left leg and he can't really get him to do all the exercises correctly. He did say that even for the rehab therapists they were having a hard time getting him do them properly.

New exercises

• Torso strengthening- Gently place hands on either side of the hips and rock your pet from side to side engaging the core torso muscles and promoting hind limp weight bearing. You can do this while your pet is eating. Guinness does fine rocking him on his good side but when you rock him to the other side to shift weight on his affected leg he doesn't put it down and just tries shifting his weight on his good side, looses balance and starts to fall.


• Cookies at contra-lateral hip- Have your pet take a treat from near the hip on the good side. This created bending away from the good side and shifts weight onto the problematic side. Does the same as above, doesn't put his leg down just tries to shift weight on good leg, looses balance and starts to fall. Hard to do without a 2nd person, because you have to support his abd. with one arm and give him the treat with the other.


• Sitting exercises- Ask your pet to sit and encourage them to tuck the surgical leg under the body by tapping on the foot. Rewarding your pet with praise/treat when they accomplish this task will encourage them to sit squarely each time. Tricky maneuver but I can get him to do it, again alot easier with 2 people.


• Three leg standing- Lift the good hind limb off the ground and extend it backwards. Support this leg from the knee as opposed to the shin or foot in order to discourage our pet from weight bearing through your hand and support. Haven't really been able to do this one properly, he is too off balance while I'm supporting his abdomen, he's just bearing weight through my support. But I think this one is prob. the most weight bearing exercise and thus will take more time for him to do properly.


• Paws on counter- Have your pet place their front paws on the 2nd or 3rd step of a staircase or on a chair and offer a cookie from above its head height causing weight bearing in rear and stretching of back muscles and hip flexors. Tried this one with an exercise step I have and he can do this one if I lightly hold his affected foot down to the ground, he still has the tendency to hold it up and bear all the weight on his good leg.

These are going to take more time to get down properly. I really do feel like these need to be done with 2 people, Doug said the rehab therapist was using her assistant alot with these too. So maybe we can try them tonight when Doug gets off work because they are rather difficult to do without assistance. We tried doing them last night for a little bit so I could see the techniques but trying them alone this morning is alot harder. He still didn't do them exactly right last night either with assistance. I do anticipate with time and him learning the exercises through repetition and getting more confident with bearing weight on his affected leg, that I will be able to do these unassisted. But for now I think Doug and I will need to do these together. The rehab therapist did say that Guinness was showing he is still fearful to bear weight on it during the rehab session and that's why he is so hesitant to do so. Little baby steps I guess......Maybe today he doesn't do them at all properly but through repetition and practice he will gain more confidence and do them better with time.

Another exercises we get to do with him his leash walks, yea!

Leash walks- Leashed walks may be taken for 5 minutes twice daily. Gradually increase walk time by adding 5 minutes each week. Walks are to be very slow to encourage Guinness to bear weight on his affected leg. In contrast walking too fast Guinness will only continue to hold up that affected leg.

These exercises are all so time consuming and will take practice because Guinness is still learning them. I'm not exactly the most patient person so I'm having to adjust and put his needs ahead of my own and trying to find some time to be productive in the house. I am taking time for myself though as well, whether it's just a drive out in town to get out the house or going to the aquarium/six flags this .past weekend. I look forward to my vacation in August. :)

One week post op 7/6/2010

7/5/2010
So I guess the calm medication is working, Doug called me at work and said he had been pretty docile all day. He still wants to run and play but is coping better with being alone and not whining as much throughout the day.

7/6/2010
On a different subject...When he came home from his surgery the first day I started mixing his dry food with wet. We usually only feed him dry but I figured he would be more inclined to eat it with wet mixed in, he loved it, no surprise. Prior to surgery I would mix some wet food in occasionally just as a special treat, maybe once every 1-2 months. Ever since the first day post surg. I have continued to mix some wet in, but on Saturday I tried dry only and he wouldn't touch it, only if I hand fed it to him. I had to go to work so I mixed in the wet and let him eat because he has to take his medications with food. Today, 7/6, Doug tried giving him dry only (so I could sleep in, sweet hubby) and again he wouldn't eat it. So again I fed him wet food mixed in so I could give him his meds. I have read on different sites that it is better to feed a combination but Guinness doesn't always eat his food in one seating, so I don't want it to sit all day....and its not real convenient for traveling, so I'm not sure If I want to get him accustom to eating comb. everyday.

I have to get something productive done in the house today, I have been consumed with helping Guinness lately and neglecting the dishes and laundry. I need to vacuum again too, Guinness has been shedding alot lately for some reason.

7/6/2010 9pm
Oh my goodness, the dog has whined all day. I gave him his food in the morning with his med.s including the calming pill (that didn't seem to help much today). I did his exercises and played a bit but then I put him in his little room he is staying in and tried to be productive in the house. I let him out several times, I took him out front while I watered my flowers and let him chill out in the basement room next me while I checked my emails. I did get some stuff done but he whined and whined all day, I presume because I secluded him and he could hear me move about the house. Doug and I had dinner when he got home and then we went out for a swim, it was good to get out of the house and not hear the whining. I think Guinness' cabin fever is driving him nuts, it's certainly starting to drive me nuts. When we got home I did his exercises, cold therapy, and gave him his shot, again no cry with the shot :) I let him lay on the floor while I watched tv but he just whined and appeared to need to go out, but I took him out several times and he would just walk to the fence like he wanted to go for a walk. Within 5 minutes of being brought inside he would start whining again. I finally put him in his little room with his cone collar, I can't take the whining. He whined for a few minutes then I'm assuming he is sleeping now because he stopped. Lord, give me strength.

Happy 4th! 7/4/2010

So Doug survived the 2 days by himself taking care of Guinness. He gave him all his meds, took him out, and did his cold compress 3 times a day. He did say that Guinness is getting a little more whiny about not being able to run and play, he has cabin fever from being all cooped up. When he is let outside he wants to run and doesn't want to be held back. The vet did say by day 5-7 they generally perk up, think they are healed, and want to run and play like always. So with that said, it's normal for his recovery, but we have to keep him calm and not let him go wild.

I've noticed the change too, so I have been trying to keep him occupied when I'm home. Lay him down and play with his toys, trying to keep him busy. However, his dressing came off and he wants to lick at it now. The incision looks good for now, but his last antibiotic is on Monday, so we have to be diligent about now letting him mess with it. For the most part I have been keeping his collar off when I can directly watch him (before the dressing came off), to give him a break, but now I have to put it back on while I'm watching him because he wants to keep messing with it. Just a few days ago, toys were enough of a distraction but they're only working intermittently now. The vet said not to redress it, but I did put some steri-strips on it. Steri-strips are used on incisions post surgery to help reinforce the incision and help it to stay intact, we use them at work on our c-sections. With the incision being on the knee, it increases the chances of separation due to bending and extending the leg, so it's just in case. :)

On the 4th, I decided to buy him some calming medicine from petsmart. I can only imagine how frustrating it is for him to be cooped up for weeks, not being able to do much and having to wear something so big and acquired around his neck when alone (he cant really play with his toys while wearing it, bumps into things, and prob. isn't too comfortable). He has to wear it for the next 2 weeks (until next Monday), when he has his follow up appointment. At that time if the vet says it's completely healed we don't have to use it anymore. But until then he has has to use it. I don't want to put him on sedatives so the calming medication seemed to be the next best thing. On the bottle it says: to help to ease dogs through stressful events. Other bottles read: helps with anxiety, hyperactivity, travel, boarding, storms, grooming, and sometimes day-to-day living. So we will see...

Happy 4th, enjoy the fireworks!

Let the journey begin 7/1/2010

So today I reread Guinness' recovery papers and realized I need something to keep me on track, it's alot to remember. So I made a sheet with all his medications/ROM exercises/cold compress schedule on it to keep me in line and to ensure nothing gets missed/forgotten. I have to go back to work tomorrow so Doug is going to have to take over for the next 2 days. I hope my little sheet will help him.

After several phone calls to my reg. vet I finally was able to speak with Dr. Walters who told me I could come and pick up the Adequan and give it to Guinness at home. I don't know how much they would charge to give it (IM injection) but for 8 shots, even $10 a piece would be $80 along with the inconvenience of taking him to the vet twice a week for 4 weeks. Yea, money in my pocket:)...well, it will go towards his rehab visits. I gave him his first shot tonight, I was so worried how he would do but no shiba scream tonight. Doug held him and he took it just fine. He doesn't do that well with shots at his normal visits with the vet, hehe not to brag :P He didn't make a peep, he got a treat and lots of kisses afterwards. He is spoiled rotten!!

So far he has been doing very well. A little too eager to want to get up and walk around but what can you expect from a puppy. He is not real excited about the 15 minutes of cold compress, the elk antler/other treat hold him for about 10 minutes but then he gets a little whiny. He isn't bearing weight on his left leg yet but intermittently putting it down when he eats and when he eliminates. Amazingly he does sleep alot during the day, which is great and pretty tolerant of his cone too. I don't keep it on when I'm watching him though, only when I leave him or sleeping at night, that thing looks pitiful. Taking care of him is a full job.

We put down mats in our utility room and thats where he is going to hang out during the day when we are at work. That way its carpeted and he doesnt slip and fall. The bathroom door is closed and baby gate up to the hallway, so he doesnt feel trapped in with double doors.He has spent a few hours in this room while Doug and I were eating tonight and a shopping trip this morning but hasnt stayed in there for a full day of work yet, so I hope he will be ok tomorrow.

Home sweet Home 6/30/2010

So happy to have my boy home! He is 9 months old today. He was supper excited to see me at the office....he missed his momma :P

I met with Holly, the discharge tech., who explained what life is gonna be like for the next 6-12 weeks. Let's just say its involved!!

• He is on Rimadyl (anti-inflamatory) for the next 2 weeks, Cephalen (antibiotic) for 5 days, can have Tramadol for pain med. when needed (prob. last 1-1.5 weeks), and will need to get adequan (helps protect against osteoarthritis) IM injections for twice a week for 4 weeks. I'll have to call the vet and see how much adequan injections cost, she will probably charge for administering them so I will prob. do them myself. Being a nurse is handy sometimes.:)


• When not suprivised he is to be crated or kept in a small space, and not allowed to run, jump, or play. He may have short leash walks to go outside for elimination only for the next 2 weeks. He must wear his elizabethan collar (lampshade) at all times unless directly suprivised.


• I have to apply a cold compress to his knee for 10-15 minutes at a time, 2-3 times daily , for the next 3-5 days. I have to start doing ROM exercises with him in 5-7 days post-op, 4 different exercises, 10 repetitions each 2-3 times per day. Cold compress post ROM excercises 10-15 minutes.


• 10-14 day incision evaluation and first apt. with rehab therapist. I will then learn his second set of at home exercises.


• Weekly apts. from then on-for rehab therapy and potentially start hydrotherapy at 6 weeks. Repeat xrays at 4 and 8 weeks.

Man I'm tired just rereading all that. At once that's all done it will be september and Doug is getting his surgery. Boy, I have my work cut out for me.

Synopsis of lead up to surgery

Since mid-May we noticed Guinness had been limping intermittently on walks and at the dogpark. We took him to the vet and they did xrays and an exam which revealed left sided hip dysplacia and bilateral patella luxation (Left-Grade II, Right-Grade I). They're recommendation was to do the FHO procedure to correct his hip dysplacia.

We spoke to our breeder: My husband called him when we initially got the xrays and first diagnosis, our breeder told us he would pay us what we paid for Guinness towards the surgery ($800) but we really should consider putting him down and he would give us another puppy. No way, Guinness is my baby!

We wanted a second opinion regarding what kind of surgery to do, so we went to VOSM (orthopedic specialist) and had a consulation with Dr. Lotsikas. After his examination (bilateral hip dysplacia, and bilateral patella luxation, same grading) and review of xrays his recommendation was to perform MPL surgery on Guinness' left knee.

So Doug and I were left with 2 different plans of care for Guinness. After hours of online research and questions to Dr. Lotsikas we decided to go with the MPL surgery. $2400-$2600.

Guinness' MPL Surgery 6/29/2010

Guinness has his MPL surgery today on his left knee, 6/29/2010. Doug and I took him to VOSM and got him all checked in, I hated saying goodbye, I told him see ya later and gave him some love. It was hard but I didn't cry like I thought I was. He weighed in at 27.2 lbs, the biggest he has ever been. He will be 9 months old tomorow.

So I went home and started cleaning the house, trying to take advantage of not having Guinness to entertain. :) I did laundry-including washing all of his bedding (3), sweeping/mopping, vaccumming and bathrooms cleaned. It helped but I still worried.

The nurses called around 3pm saying he had not gone into surgery yet (he was #4 in line of 6) but they had taken him outside a few times for walks and she said, "the staff love him, he so sweet." She told me that 4 hours after surgery they will take out his trach and try to take him outside to pee. Every 4 hours thereafter they will do the same, they'll get him up and walk him outside. She also told me that Dr. Canapp had seen Guinness (We asked that prior to surgery we wanted Dr. Cannapp to see Guinness and give his opinion of what surgery we should do). He agreed with Dr. Lotsikas that we needed to proceed with the MPL surgery, his evaluation however was that Guinness' left knee was a grade III. Dr. Lotsikas evaluation was that Guinenss knee was a Grade II, sort of relative but the conclusion is the same, that Guinness needed MPL surgery.

A little education for you in regarding the grading of patella luxation. There is a grading system of severity.

• Grade I- the patella can be manually luxated but is reduced (returns to normal position) when released
• Grade II-the patella can be manually luxatd or it spontaneously luxate with flexion of the stifle joint. The patella remains luxated until is is manually reduced or when the animal extends the joint and patella moves back into place. (intermittently luxates but stays in place more than out) This is typically the dog that occasionally carries a rear leg for two or three steps on occasion but then puts it back down and goes as if nothing was wrong.
• Grade III-the patella remains luxated most of the time but can be manually reduced. (stays out of place more than in) They have more frequent "skipping" episodes, may not want to jump up onto things, they may have pain and the patella doesnt alwasy return to normal positioning when it is deliberately pushed out of its groove during a physical exam.
• Grade IV - the patella is permanently luxated and cannot be manually repositoned.

Dr. Lotsikas called around 6pm and told us the surgery went well and he was very pleased. He said that it was the right decision. Once he saw the structures he said that Guinness barely had any patellofemoral groove, "it was nearly flat". The patella rests in the patellofemoral groove, if its shallow (in Guinness' case) then it is prone to luxate (dislocate).

This news makes me feel so much better about going through with the knee surgery instead of his hips. Doug and I were told by our original vet to do the FHO surgery on his hips (he also has bilateral hip dysplacia), then we went to VOSM and saw Dr. Lotsikas (orthopedic specialist) and his opinion was that we needed to correct his left knee with MPL surgery.

Around 10pm I called to check in on Guinness. She said that he did well with his first walk and went outside and peed. They did have to "tweek his pain meds" she said when asked if he had been whining, so I guess he needed a little more. She said that his vitals were stable and is doing well.