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Surgical implant pain

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So I’ve had a busy fall. Which included Kenzi having a second arthrodesis surgery on her other front leg. Four months later her bone is completely healed. And the surgical/implant area is very sore. A combination of anti inflammatories and gabapentin and there’s some still pain/limping. Without the meds she holds the leg up. Bump the area and there’s a noticeable reaction.

 

We went back to the surgeon today to get it checked out. Again (our final visit was supposed to be at the beginning of Januaryy). Everything looks correct leg wise on X-ray. Bone is fully healed, nothing has loosened.

 

The surgeon confirmed was I was pretty positive about -  that the surgical area was definitely the source of pain.

 

Of course he said it was highly unusual and not something that there was much data to go on (board certified surgeon so some decent experience with this sort of thing). Gave me to options of long term significant medication and see if it improves (it’s been sore and gradually worsening since the beginning of December until we added gabapentin in January) OR Surgery to remove the implant - he guessed that there was a good possibility of improvement, but couldn’t guarantee anything.

 

Ugh! This stinks. With all the drugs, she’s pretty happy and semi active. But she still favors the leg a bit even with the drugs. And when they wear off it’s worse. 

 

We added in Tramdol today while I decide what to do. Right now I’m leaning towards giving it a couple weeks on the increased medication and then opting for implant removal if it doesn’t improve. 

 

She’s 10 and otherwise pretty healthy. I hate the idea of more surgery but I also don’t like the idea of leaving her with a leg that’s sore for the rest of her life. I have insurance for her so the cost isn’t a major consideration. It’s just a huge bummer. And surgery does have risk of complications and not a sure cure.

 

Any thoughts or experiences with this sort of thing? What would you do?

 

 

 

 

 

 

 

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I'd do the surgery.  I don't have experience, but it seems to me long term use of heavy pain killers have greater cumulative risk than the surgery.  It also seems like removing the implant has a decent chance of removing the pain.  If it, for some reason, doesn't, the option of medication is still there. 


But if medication compromises her liver or kidneys, the option of surgery may go away, or become much riskier.

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I am sorry to say I don't have advice. But I wanted to reply to say that I really get the dilemma you are in and I would be pretty uncertain about it myself. I have a dog with an implant after having had ACL surgery. And I would also be very reluctant to do surgery again especially on a dog who is no longer young.

I am sending you my very best mojo for Kenzi, and good energy to you for being able to come to the best answer. sorry you are going through this.

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I guess the question for me is whether removing the implant is going to relieve the immediate pain only to cause other pain.  I am sure the original surgery was a well considered choice because the alternative was a negative outcome.  Does removing the implant mean Kenzi goes back to the negative outcome? Does the removal also mean ongoing pain or loss of function?  Would that be worse or better than the current situation?  Are you balancing function versus pain?

I don't know enough about your situation to know what the answer is, and it is a horrible dilemma to be in.  I am not generally in favour of long term pain relief, partly because of side effects and toxicity, but also because, at least in humans, it can actually make pain worse over time.  I have no idea if it is the same in dogs.  

Sorry I can't be more help.  I have no answers; I have never been in your position and I suspect it comes down to a very personal decision in your particular circumstances with no absolute right or wrong answer, only what is right for you and Kenzi.

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I called today to schedule the surgery which will be next week. The bone is stable. I mean, the screw holes will have to heal but besides that it’s healed and solid. They gave me a time frame of four weeks healing. There’s a chance of complications but, from everything I’ve heard/read, a much better chance that this will solve the problem. 

 

She needs major drugs every 8-10 hours to stay reasonably comfortable right now. When she’s comfortable she wants to do all the things. And she’s Happy. 

 

If we can solve this, she’ll be able to be a therapy dog at the medical school where I work.

 

And then the big push for me was I spent Saturday with a friend and she abruptly lost her 8 y/o dog to hemangiosarcoma. She came to train SAR Dogs with me. Got her dog out of the car, saw that something was very wrong, and we headed to the emergency vet. Her dog passed in surgery due a combination of factors.

 

She couldn't fix her dog. But I have a good chance of fixing mine so I have to try.

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Wishing you and Kenzi all the best with the surgery and hoping for an uneventful recovery.

If she's anything like Bodhi she'll have a wonderful, fulfilling life being a therapy dog. :) Bodhi's now at least 13 and still loves going on his visits.

 

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Surgery was yesterday. Simple and straightforward. And she handled it super well.  They started at 1 pm, let me know at 3 that I could pick her up later that night and called at 4 pm saying she was ready to go. I was impressed with that - yay for the right anesthesia protocol for a senior dog! There was one screw that was a bit loose, but otherwise nothing that pointed to a cause for the pain. They sent the implant out for a culture just in case. 

 

She still loves everyone at the referral hospital and the surgical tech told me that they were discussing who got to adopt her on the slim chance that she ever needed a new home... 

 

 

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Bacteria culture came back. Positive for staph. She had developed a few minor pressure sores from the splint back in December shortly before the limping started. I’m guessing that could have led to this.

 

She’s been a different dog since surgery. She was started on prophylactic antibiotics then which were appropriate for staph and she’s using her leg almost normally now. And she’s gone from acting “old” to “normal”. It’s soooo good to see.

 

 

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I am so happy to hear that the mystery has been solved as to the cause of the problem.  Even more importantly, Kenzi is back to being a happy dog again! Yay!

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Really good news!

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And the leg broke. I could feel it moving last night. Vet visit this afternoon. 

 

I’m pretty upset about all of this right now. My poor dog. And I’m exhausted.

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Oh, no! So sorry for you both.

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So yeah.

 

The repair failed. It took a couple weeks to figure it out because regular vet couldn’t identify what was going on and surgeon was out of town (and it can take a few days to get in there). For some reason, the bone never healed properly. And didn’t hold up.

 

So now I have to decide if I want try to fix it again. Or amputate. I’m leaning towards trying to fix it again. Which they told me still has a really good chance of success. 

 

But in the mix of things we found a heart murmur. So she’s having an echo done next week and I have surgery scheduled for the next day.

 

My poor dog. 

 

Does anyone have any info on why bones might not heal? Just want to make sure that I’m not missing something before sending her back for more surgery.

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I am sorry but I don't know what to say. I just wish you both the very best possible outcome and a safe and uneventful recovery. 

Very best wishes to you both. 

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I'm also sorry to hear this, and like Sue have little to offer.

Integrative medicine may have some suggestions. Herbs such as boneset and comfrey (aka knitbone) come to mind, though I'm sure there are others as well as certain foods (do I remember zucchini being one of them?) or homeopathy that might assist with optimal healing. And there are things such as elec. stim, ultrasound and magnets that have been used, though I don't know with what success.

If this were my dog, I'd probably have a second consult with an integrative/holistic/alternative vet for ideas and perhaps even something that I might be able to start ahead of time to increase the chances of optimal results.

As always, I wish you the best no matter which way you decide to go.

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