Bug FHO Update #5: Rehab

Bug has now completed 5 weeks of underwater treadmill therapy, and we're seeing a HUGE improvement!

We had to wait to start the treadmill until she was weight bearing on her leg, and to get there we did "assisted weight shifts" for a few seconds at a time by supporting her butt and gently lifting the good leg. We also walked around in her pool (see Bugzercisor video).

The biggest change I've been noticing is a huge improvement in her attitude. She's much more relaxed, even in new situations. It's a similar change to when I started her on fluoxetine. I had known she was in pain from her hip, but what a difference less pain makes! She's much less reactive to other dogs and less anxious. I'm so excited to see what this does for her learning ability (dog parkour, agility, and disc dogs, here we come!!)

Below is a short (ok, long-ish but adorable) video of her first vs. fifth sessions on the treadmill. Shout-out to Animal Clinic Northview for the AWESOME rehab program and Susan RVT for all the help with the Bug-let!

Bug FHO Update #4: pre-weight-bearing rehab

Bug working on rehab exercises and swimming now that her stitches are out. Most of this was filmed week 3 after surgery. Both Bug and the pool tried to die this weekend, luckily only one of them succeeded!

We have an appointment with a rehab veterinarian tomorrow!

Bug's Hip Dysplasia - Update #3: Post FHO

Bug is now 48 hours post-op! 

I've written some thoughts on the past day and a half since I picked her up from the vet.

1. I think Bug is sleeping better than I am! She has a memory-foam doggie bed set up in her "house," while I fitfully slept on a backpacking mat next to her. She's napping a lot, which is good for her recovery. I am just tired without end!

Napping with a snack #winning

2. Last night bruising started appearing. There's a purple mark along her femur. It's to be expected, along with this morning's swelling. I've been icing 20 minutes every few hours to keep down the swelling and pain. She doesn't seem to mind the ice sitting on it.

Bruising at 2 and a half days post-op

3. Her good leg is SORE. She's 90% 3-legged, so that poor hind doing double duty is quite tired, although she's getting better at lying down somewhat slowly, rather than attempting and falling onto the sore hip (she doesn't like me to help, she'll just stand tense and stare at me).

4. Range-of-motion exercises are really difficult - for me! Due to the nature of removing a joint completely and depending on scar tissue to compensate, making sure scar tissue doesn't form limiting the range of motion of the "new" joint is very important. I was instructed to do "75% of normal hip movement 7-10 times, 3 times per day." I'm not entirely sure what 100% range of motion is, so I've been going to the just before the point of pain as gently as I can. I can usually only do about 3 or 4 reps before she decides she's very done. Flexing she's ok with, extending is OUCH. She whines and considers nipping me, so I feel horrible doing this to her!

5. Bug does not like the cone of shame! She's been AMAZING about not licking at her sutures at all, but I've been putting it on while I'm not directly supervising her. Having awesome friends (canine and human!) Bug was able to borrow an inflatable donut "cone" that she likes a lot better - that also functions as a great (wear-able) pillow!

For the near future:

• carefully continue manual ROM
• more ice, crate rest
• soon, short walks on leash (slow!)
• make a consultation appointment with agility/rehab veterinarian Dr. Kathy Topham
• recheck/sutures out (14 days post op)
• one day after sutures are out, start swimming! See: The Bugzercisor! 

Bug's Hip Dysplasia - Update #2: The Bugzercisor

D-day is scheduled!! I'm dog/condo sitting for a friend a week in July, so scheduled the surgery at the very beginning of that week. The details seem to be fitting together perfectly - the condo we're at has a same-level patio for dog potty trips (no stairs!) and little, polite dogs (no behemoths *cough* ROMAN*cough* to knock a sore Bug down).

I had planned on getting a referral when back in Cleveland for PT/rehab because, with an FHO, early and intense rehab is critical to a getting functional false joint. This is because scar tissue is forming the joint - if range of motion exercises aren't done during recovery, it will be limited. Doing a lot of reading on FHOs, the consensus seemed to be that "hydrotherapy treadmill" is what's usually done by veterinarians to rehab dogs (a treadmill filled with water to add resistance and encourage more range of motion), but swimming is almost ideal. So I did some researching and found that a pool deep enough for Bug to swim in was surprisingly cheap at walmart!

Bug's Hip Dysplasia - Update #1: X-rays

I took Bug to the vet today (after much confusion with the receptionist over FHO vs. OFA and ortho vs. repro specialties).** We had good x-rays done under sedation and compared it to ones from last July to see the progression. The BEST news is her right hip looks great still! Her left is showing some pretty serious arthritic changes, but she's a perfect candidate for a Femoral Head Osteotomy (FHO).

Go home, Bug, you're drunk! The sedatives
lasted a bit longer than it took to take x-rays ;)

An FHO is where they remove the top of the femur that's supposed to rotate within the pelvis, because none of it is shaped right and it's currently just grinding bone-on-bone (OUCH!). This creates a "false joint" of muscle after healing, removing the source of pain and inflammation from the dog. Some range of motion is lost, but no more pain! Some reasons she made a perfect candidate:

• she's a small or medium sized dog (less than 45 lbs)
• she's an active dog that stays leaner, unlikely to get overweight and overstress her "good" hip
• she doesn't need it done bilaterally - one hip is good as is, so only rehabbing one side is necessary

There's a few other surgeries that treat hip dysplasia, but Bug isn't really a good candidate for them - triple pelvic osteotomy (TPO) is done for puppies that have signs of hip dysplasia but do not yet have arthritic changes to the joint. This surgery re-orients the pelvis, so the angle of the hip socket is better. A total hip replacement (THR) is exactly what it sounds like - bionic puppy hip! However, it's extremely expensive. They recommend THR for larger dogs that would be too big/heavy for an FHO to be as successful.

Now for what you've been waiting for -- the x-rays!

This is from a year ago (Bug was almost 2). There are some arthritic changes and you
can see the left hip (right side of the image) doesn't sit in the socket entirely.

Image from today, two weeks shy of exactly one year later. Bug's right hip
(left on the image) looks good still, but there's a decent progression of arthritis in the
 left hip - the femoral head is no longer smooth and correctly shaped, but
bumpy and rough from grinding in the joint. 

Although it's sad to see how much the arthritis has progressed in a year, I'm glad to have one more expert agree that an FHO is a good plan for Bug. She's still a young dog so I can pretty easily make her life less painful. We've scheduled the "big day" for a month from now while Bug and I are in Columbus watching a friend's dogs. Follow along for pictures/video and updates of Bug's process and recovery!

There's exactly one day left for the Bug shirts fund raiser! https://www.bonfirefunds.com/see-bug-run We sold TWENTY SHIRTS!! A HUGE thank you to everyone for helping my little dog! The fund was successful, so start looking for yours to come in the mail mid-July (right when Bug is going in for surgery!)

**OFA is a registry for pure-bred dogs to prove a veterinarian has x-rayed and examined hips and elbows for genetic orthopaedic problems. I have no clue why they thought I'd want my spayed, mixed breed to get an OFA exam, but.... eh?

Bug also got to do some paddle boarding before the vet appointment today, so today wasn't all bad!