Tuesday, 13 December 2011

All about Becky

Poor Becky has been through a really rough time over the past ten months or so.  It started with rear leg lameness at the beginning of the year.  We had x-rays done and nothing was conclusive so with the support of our vet we tried to manage the lameness with pain relief, restricted exercise, swimming, massage and physio.  For a time it worked and although the lameness never completely disappeared we felt that Becky was enjoying her walks and life in general.  We were all pretty sure the source of pain was emanating from her knee as it was swollen and she showed stress when it was manipulated.  However to complicate matters she also had two areas of pain in her back and therefore there was a possibility of referred pain.

Then at the end of October the lameness got worse and we awoke one Sunday morning to find that Becky was holding her leg completely off the ground.  Our immediate thoughts were that she had ruptured her cruciate ligament.   We got an appointment with our vet on the Monday morning and by this time she was weighting the leg again but only slightly.   We all agreed it was time that Becky be referred for more extensive tests and we chose North Downs Specialist Referrals not just because they are local to us but because they have so many areas of expertise and at this point we were unsure if the issue was skeletal or soft tissue.  Nico, our vet, especially wanted us to see Terry Emmerson because he is a specialist in both orthopaedics and soft tissue.  Unfortunately he was on holiday so we had to wait for nearly three weeks for an appointment during which time Becky's lameness and pain got progressively worse.  We decided to try her on Rimadyl to see if that would be any better than the Previcox.  I so wish we hadn't asked for that (you will understand why later.)   Nico wanted her off all pain meds prior to her appointment so we made sure to do this but as our appointment got closer we noticed that someone had been peeing overnight. Sometimes it was on the back door mat and other times a bed was completely saturated.  We weren't sure who it was as Niamh was on steroids at this time for a skin problem.  We knew we would have to isolate her and Becky to find out who it was.  

Anyway off to North Downs.    Terry Emmerson is a very nice guy and he gave Becky a thorough, if brutal, examination.  He agreed she has some pain in her back but he was 99% sure that her main source of pain was coming directly from the knee.   Like our own vet he felt it wasn't severe cruciate damage as the joint was pretty stable.  He suggested the best route would be for an MRI scan and at the time they would also do a neurological test to make sure that the pain wasn't coming from the area in her back and also take some fluid from the knee to run some tests.    He suggested that it was unlikely that Becky would have surgery and that more likely we would medically manage whatever was going on.

We had to wait a week or so for the results although Terry rang us on the evening we collected Becky to say that in his opinion there was nothing nasty going on.  He would be back in touch once the scans had been printed and read by their radiologist.  Unfortunately nothing really showed on the scan apart from a thickening in the knee joint which didn't look sinister but wasn't quite right.  He said he was going to get another opinion on this but it was unlikely anything would be conclusive and so we would manage Becky's pain with medication: continue with Rimadyl and add Tramadol.  Not very satisfactory but he had warned us that sometimes things aren't always clear cut.

In the meantime the peeing was getting worse and we identified that it was Becky.  I had an inkling it could be the Rimadyl although this isn't a published side effect of the drug.  So, I stopped it and rang the vet.  Becky then had to have urine and blood tests and these tests showed that her urine was too dilute but that her kidneys were about right for a dog of her age.  After ten days off the Rimadyl she started to return to normal which was a relief but because she was no longer on anti-inflams her pain returned big time.  She would/could no longer put her leg to the ground and was carrying it under her belly most of the time.  She was panting and stressing and we were beside ourselves.  So, we rang Nico and asked him what could we do.   We took her into see him and he was sad to see that her knee had swollen considerably since being off the anti-inflams   He advised it would be wrong to put her back onto anti-inflams as there was a real possibility that we would damage her kidneys but he would understand if we chose to do that as he was sympathetic to our worries about her pain.   He suggested we go away and think about things and we would re-group the following week.   We made the decision to put her back onto Previcox and within a day her pain was better although she still wouldn't put her leg down.

Things seemed a bit better but then the peeing started again and we felt totally between a rock and a hard place.  We called Nico in despair and he started the conversation about removing her leg.  This was last Monday and we spent most of the day either crying or on the phone to either Nico or Terry Emmerson.  Terry was very kind and suggested we have biopsies done but it would be up to three weeks before we got the results.   Terry and Nico spoke and then we talked with Terry again and we told him we had decided to have the leg removed.  Our thinking, along with guidance from Nico, was that whatever results came back from more tests the fact would remain that the leg was causing Becky huge pain and that had to stop.  Against us was the fact that we could no longer administer anti-inflams and so every possibility had to be considered.  Both vets felt that Becky's pain was disproportionate to what was showing on the MRI scan and X-rays.  Nico felt that something was being missed and that the level of Becky's pain was that which he would expect to see in a dog with some kind of tumour and that means a great degree of unmanageable pain.  Terry said it was somewhat unorthodox to remove the leg prior to biopsy but he also said he could understand why we were going down that route.  So, the decision was almost made and we decided that we wanted our own vet to do the operation.  Terry asked us why not North Downs (fair enough) and we said our decision was very easy to make: Becky loves Nico and all his staff and goes into the surgery with her tail wagging looking for the biscuit barrels and importantly we can take her into the surgery about 20 minutes before her op and be with her as she goes to sleep on the table.  Easy decision I think!

Nico invited Andy back to the surgery for one last chat before we finally made up our minds and during that meeting he explained exactly what he would do during the procedure and what we could expect.  Andy said we would go ahead.  Once he had made that final decision then Andy was anxious to get the ball rolling as we were in such a state by now.   Nico took his diary home with him so he could call his other clients and cancel all procedures, bar one, for the following day so that Becky could go straight in.  I am so grateful for this.

So Tuesday dawned and I awoke feeling very down.  It's one thing for this to happen when there is no choice but when you are actually making that choice you question over and over are you doing the right thing.  We got the call to take Becky in around 12.40 pm and had one very last chat with Nico.  He was totally understanding of our dilemma and said he felt pretty much the same himself but like us had concluded that it was the right thing to do.  He felt her leg one last time and she cried , he also reiterated that he had a gut feeling that there was some kind of cancer/tumour for this level of pain.  That was enough for us we would go ahead.    We went through with Becky and she went off to sleep very easily.  We waited whilst he took some precautionary chest x-rays.  He came out to tell us that these were clear and therefore he would go ahead.

He assured us that he would only send her home if he felt her post-op pain was under full control otherwise she would stay in.  He had already explained that she would be pretty spaced as he would be keeping her dosed up with opioid analgesia.  This was his only option due to her anti-inflam intolerance.       He called us once the op was done and said it had gone exactly to plan and that she was sleeping on a heat pad with lots of blankets over her.  He said he would call us again later for an update.

True to his word he called at about 6.30 pm.  He said she was very stoned and quite high maintenance with a drip etc.   However, he had offered her food which she wanted but was too unbalanced to manage herself.  So he sat with her and rolled the food into meat balls and hand fed her.  He felt she would be too much for us to cope with that first night and so he was taking her home with him.  It made us feel very happy that she would be in such good hands.  When we went to collect her the following day he looked wiped out and explained he hadn't got that much sleep as she had needed quite a bit of care and hand feeding.   He also said he had been kept awake worrying that if her pain was really in her back then how could it now manifest itself now that we had taken off her leg.  But then he talked himself back into the space where we had all been the previous day; where we agreed the pain was coming from the knee and that it was the right thing to do.  He was pleased that we had slept better - bless!     We are very lucky to have such a brilliant and compassionate vet.  He and his whole team are simply fantastic.

Becky's first night home was pretty awful.   Andy slept with her and between them I think they had about an hour's decent sleep.  She wouldn't/couldn't lay on the side of the amputation, understandably, and that was adding to her frustrations.  She was very agitated and stressed. She wore a buster collar and Andy had her lead around his wrist so he was aware of her movement.  She needed to go out quite a lot during the night and was leaning and listing.  It was very scary and we felt very emotional and helpless.

The following morning we made her a very special bed of double memory foam, a folded up duvet from one of the spare beds covered in a soft fleece blanket.  This meant she was on a very soft but supportive bed and importantly completely elevated off the floor.  What a difference.  She was much more comfortable and would now lie happily on the side of the amputation.  

The stitches are obviously tweaking as every so often she would try to get at them but one of us is with her all the time so we make sure she can't lick or bite at the incision site.  Some bruising and a bit of a swelling started below the incision but the following day the swelling was all but gone and the flesh is just purple/red.

Leah came to visit Becky on her first proper day at home.  She commented on what a fantastic job our vet had done.  She thought it was one of the neatest amputation sites she had seen.  That was good to hear.

By now, slowly but surely she was starting to improve.  Interestingly, Leah commented on something that I was feeling.  She said although it was obvious Becky was post-op sore, she seemed less unhappy in her general demeanour.  She said her face looks like the usual Becky rather than the one we've all been seeing over the past months and weeks.  

We have bought her a Ruffwear harness for when she can go out on proper walks.  This will be very useful as it has a handle on the back and we will be able to quietly help her with bridges and styles etc without making it stressful for her.  She hates being lifted and man handled.

Her balance and ability to get around  to go out for a pee etc is quite amazing.  The leaning and listing has almost disappeared.  She will lie on her back with her legs (and stump) in the air.  She hasn't done that for many months as she has been protecting that damn leg.    I cried first time I saw her do this.  Her hair is already starting to grow back and her stitches are due to come out this Friday.   This morning she hopped up onto one of the sofas - we are really getting there!

We are gradually introducing her to the other dogs and having them back in the sitting room for the evening.  We are making sure they stay calm and don't go near her (that means Tidal Wave in her soft pod as she doesn't do calm.)  We have to protect her operation site from being bumped or knocked.   We remember Nico's last words to us as he put her into our car: "don't bump the stump!"

Now we have to hope that once the last lot of anti-inflam has finally cleared from her system that the excessive drinking and peeing will stop.  I do believe it is improving so fingers crossed.  Here are some pictures and video of our little Tri-Pawd!