What a difference a year makes

I’ve ignored my blog for a year.  This makes me sad, but i have a good reason, and that reason is actually the topic of today’s entry; it’s the Homestar Runner!

Baby Homestar

Homestar Runner came home to us in July, 2011 as a perfect little 8 week old puppy.  We had high hopes for him and we were so excited to have a puppy from two fabulous parents, even though the breeding was an accident.  Leerie and I have long admired Moose and Tantrum and we felt extremely lucky to welcome Homestar Runner into our doggie pack.

Just a few weeks after coming home, our little puppy suffered an accident.  While wrestling with another puppy outside, he fractured his leg.   A trip to the vet and an xray revealed a non-displaced tibial fracture, not in the area of the growth plate, and it seemed to be relatively mild.  The plan was 4-6 weeks in a splint, the vet expected it to heal easily.  Since he was still such a young puppy, we planned on bringing him back to the clinic to change his splint once a week, allowing for growth of the leg while it healed.

August 2011, photo by Kim Russell

Of course, keeping a 3 month old puppy quiet is not fun, but we instituted some tough love. Little Homestar rested and healed, we got a fresh splint at the vet every week, and life went on.  Six weeks after the initial injury, our vet removed the splint and handed my puppy back to me ‘good as new.’  My instructions were to gradually increase his activity level and allow his atrophied muscles to rebuild at their own pace.  Having previous experience rehabbing a puppy with an atrophied leg from a healed fracture, I felt  i knew what to expect.  Homestar was thrilled to be out of his splint and we were all optimistic.

The day the splint came off! Hooray!

Within two weeks of the splint coming off, I knew something was wrong.  Homestar was still  lame on  the left rear leg.  The muscles remained atrophied and the leg just looked “off.”  I brought him along on a trip to our excellent canine chiropractor, Dr. Perrin Heartway, and asked him to feel around and evaluate his leg.  I’ll never forget the look on Perrin’s face when he palpated Homestar’s knee.  It was very wrong.  His patella (knee cap) was in completely the wrong place.  Luxating patellas are common in some breeds of dogs (not border collies or whippets), and they are rated I-IV, IV being the worst.  Homestar’s was a grade IV, of course.  Perrin recommended consulting with an orthopedic specialist.  I’d be lying if I said i didn’t cry all the way home.

We were days away from leaving NC and driving to Indy for the NAFA Can Am Championships.  We got an appointment to see an orthopedic specialist in Illinois.  Here’s the radiograph taken at that appointment.  The quality could be better in this photo, but hopefully you can get the idea that it looked VERY, very wrong.

Radiograph, Oct 5, 2011

After examining Homestar and looking at the image shown above, the vet tried to show me on a “model knee,” what was going on.  But Homestar’s leg was so completely F-ed up, he couldn’t even force the model to do it.  The movement of his patella (it’s floating up to the left of his femur in the xray above) resulted in all the soft tissue, tendons and ligaments attached to the patella pulling his tibia out of alignment as well.  The original fracture had healed perfectly, and no one can say for sure what caused the patella to start moving in the first place.  I believe that his original splints did not fully immobilize his knee, and the patella actually went out while he was splinted.  The doctor explained that in his  opinion, although a surgeon would probably be willing to operate, the chance of Homestar regaining anything near full function of the leg were tiny. He recommended that I consider amputating the leg, and doing it soon so that Homestar could start adjusting to life as a three-legged dog while he was still young.  I’d be lying again if I told you I didn’t cry all the way home.

The following days, at Can Am, were hard.  I was still processing the news, but I constantly had to repeat it and re-tell the whole story to many concerned friends.  Leerie and I hadn’t had any time to make a decision, and we were bombarded with (all well intended) advice and condolences.  Fur Fun had our best showing ever at a Can Am event, but our happiness was a little bit tainted by the black cloud of Homestar’s diagnosis.

Some very good friends convinced us that we should at least seek a second opinion, so when we got home to NC we took him to Raleigh for an appointment at NC State vet school.  I met with the orthopedic surgeon and they examined Homestar and conducted a CT Scan of his leg to get more accurate info.  Here’s the CT

October 17, 2011 CT Scan

 

There’s that lonely little patella again, floating off in space, far away from it’s rightful home.  The CT image also shows much more clearly just how much his tibia had rotated out of place as well.  The good news that we got from the CT was all the bones of the leg were still the right length, there was only a millimeter difference between the bone length in the good leg vs. the “lucky leg.”

Dr. Simon Roe explained that Homestar’s injury was pretty unique.  Most dogs who have luxating patellas are genetically predisposed to them and present for surgery at a much later age.  He explained that he thought surgery was a good option, and he was optimistic that with the right post-op care and rehab, Homestar could regain at least some practical use of his leg and be free of pain.  The challenge was getting his patella back where it belonged, straightening out his tibia, and then keeping them both in place long enough for the soft tissue around them to heal and stabilize the whole knee.  Doing all this WITHOUT cutting any bone or compromising any growth plates was going to be difficult as well, but Dr. Roe had a plan, and I thought that sounded pretty good.  We scheduled the surgery.

Thanks to the generosity of our wonderful community, we were able to raise the money to operate immediately.   Leerie and I are forever grateful to our special friends who stepped up and helped us through this very tough time.  We couldn’t have done it without them!  Here’s what Homestar looked like the day after his surgery.

Good little patient

The surgery took 6.5 hours.  Dr. Roe anchored the patella and the tibia using some very high tension sutures basically wrapped around the knee.  After surgery, he reported to me that all of the soft tissue connected to the patella has seriously shrunk from being out of place for so long, and the big challenge in rehab, aside from keeping his bones in place, would be getting those muscles and tendons to loosen up and stretch out to a normal size.

The following two months were very difficult.  Here is Homestar 2 weeks after his surgery.  The bandage had come off and we got a real look at his ‘improved lucky leg.’  Gotta say, it didn’t look very good.

And a few weeks later……

By now, Homestar was a six month old puppy who had spent most of his life in a crate or on a leash.  As heartbroken as Leerie and I were, Homestar took everything in stride.  Through the entire process he was a model patient, and always so happy and sweet, greeting all his fans at the vet school with his whole body wagging.  We began the long process of rehabilitation and wondered where it would take us.  The vets at NC state had cautioned me not to expect any miracles.  Dr. Roe told me “it’s probably never going to be perfect,” and I never expected it to be.  The rehab specialist at NC State was even less optimistic.

Post-op check-ups 1 and 2 months after surgery revealed that orthopaedically, every thing was still in place.

After two months of healing, the knee was holding and stabilized.  But the muscles of his leg were still extremely tight and his range of motion was very limited.  His leg muscles were also still quite atrophied and puny looking.  From the outside, it did not look like a normal leg at all.

The next six months were devoted to rehab.  Homestar’s rehab routine consisted of 45 minutes of heat and stretching in the morning and at night.  The stretching was painful and neither of us enjoyed it. Here he is being very, very tolerant.

In addition to stretching and passive range of motion exercises, we had to work on getting him using his leg again.  With so much trauma and drama, surgery and splints, the poor little guy had gotten very good at hopping along on three legs and he was happy to continue that.  I had to literally retrain him to use his newly improved leg.  Here’s the very first session I did with him, less than 2 weeks after his surgery.  My goal was getting him to bear even just the smallest amount of weight onto that leg.  The short/tight muscles wouldn’t allow him to reach the ground, but i used my own body and various props instead and he picked up on the game.  In the following videos you can see him targeting with his bad leg foot.

Still a long way from normal.  We kept at it and he slowly improved.  It was extremely difficult.  Hard on Homestar, hard on me, hard on Leerie, hard on our other dogs who suddenly weren’t getting nearly as much attention as the little crippled boy.  I know it was hard on our family and friends too.  They wanted us to succeed, but really, things looked pretty grim.  One month after surgery, he was bearing weight, but still far from normal.  Here he is, out for a walk.

Instead of learning the things a normal puppy learns (sit, down, stay, fetch, come) Homestar learned to use his leg normally.  Here’s a session from November, 2011, focusing on hock flexion, where his range of motion was the worst.

We continued our routine of two sessions/day of heat and stretching, and we started walking him on the treadmill to build muscle.  The results were excellent.  Here he is 3 months post surgery, January 2012.

It even looked better when he was standing still

January, 2012

Homestar received some great supportive medical care along the way.  In addition to monthly check-ups at the vet school, he got regular massage therapy and chiropractic adjustments.  I truly believe that these were really helpful in his recovery.  Here he is, five months post surgery

March, 2012

Homestar’s recovery surpassed everyone’s expectations except for mine.  Last year when I listened to the surgeon explain his expectations, I listened carefully and never heard him say “it’s impossible for this dog to recover full function.”  He did say it was very, very unlikely, but he never said impossible.  I took that to heart and decided it meant that if Homestar and I worked hard enough, there was a chance to regain full function of his leg.  Here he is in April, 2012, building muscle and flexibility.

And here he is running on the treadmill in May

Call me crazy, but I started training him for flyball:)  It’s what we do in this family!  His knee was stable, his muscle mass was good, he wasn’t in any pain and he was as sound as he was probably going to get.  In the spring, we also opened our swimming pool and that added an entire new layer to his rehab routine!

And here is his first flyball lesson:

We worked hard all summer.  I purchased a 4 oz weight that wrapped around his leg above the hock, and I believe it was very helpful in building up his muscles while on the treadmill and in the pool.  As his muscle mass improved, his flexibility and range of motion improved as well.

In September, Homestar debuted at his first flyball tournament.  He didn’t run in any heats, he just warmed up, but it still represented a  huge milestone for him.  Here is his last warm-up of the weekend:

Next Tuesday, we will return to Indy for Can Am 2012, and Homestar will warm-up on a Fur Fun team.  We will come full circle, but I know we still have a ways to go.  Throughout it all, Homestar has been just perfect.  Whenever someone comments on how much work it must’ve been to rehab him, I tell them “He’s worth it,” and he is.  He is the happiest, sweetest dog I’ve ever known, and so willing to do anything and everything I ask of him.  It’s been a very long road to recovery, but it was worth it.

Playing flyball, Sept 2012