The Good and the Bad

On Friday I took Holly back to the surgeon for her 8-week post-surgery x-rays. If you remember, she had TTA knee surgery on December 4^th to repair a partially torn ACL and to, hopefully, put an end her chronic iliospoas injuries. Recovery has gone really well and she remained sound after surgery until January 24^th when she came up severely lame for several days. Fortunately it happened a week before our 8-week recheck, so I put her on anti-inflammatories and 100% rest until we could see the vet.

The Good...

Holly's knee looks great. Both the vet and the PT worked on her surgical knee and neither found anything to be amiss. Her passive range of motion is almost exactly the same as her non-surgical knee, and she did not show any pain or discomfort during palpation and manipulation of both the joint and of the implants. Excellent. However, x-rays showed that at 8.5 weeks the bone is still not completely healed yet…which not terribly unusual, but we had expected it would be totally filled in by now. We’ll do another set of x-rays in 3 weeks.

So, what the hell hurt her enough to be THAT lame a week ago? 

The Bad…

The PT found that she had a lot of pain in her right middle gluteal muscle and on the right side of her sacroiliac joint (SI or Sacrum). It was also extremely painful when the vet “tipped” her pelvis…essentially moving the SI joint. We did x-rays of her pelvis and spine and it showed bridging spondylosis between her L6 and L7, and that the sacrum was “tipped” in an upward position and slightly askew.

Because the x-rays show that the bridging of the L6 and L7 was nearly complete, this is something that’s been going on for awhile, and was already present before we did the knee surgery. Like other arthritis, not all dogs show pain or discomfort with Spondylosis, and its progression is different in every dog.

She’s been walking and moving differently since she tore the ACL, and especially so since her surgery. Last Thursday we think she hit critical mass…she twisted just right, pushed just right, or did ‘something’ just right to break the bridge of calcium that’s been forming between L6 and L7. Spondylosis is permanent and progressive, and we actually WANT the L6 and L7 to bridge, or fuse, together so they can no longer ‘shift’ out of place and cause pain.

So what now?

Well…for the short term, we have both the knee and the sacrum to worry about. I have a whole list of things she can do and things she should not do. We’ll continue to work on building up the strength of her knee, and at the same time start to work on getting her core muscles back in shape.

We’ll also slowly work on getting the sacrum back in place and keeping it in place. The PT suggested NOT putting the SI joint it back in alignment through chiro…the tissue around it is already inflamed and sore and she felt it was unlikely to stay in place afterwards anyways. So, I have specific massage points to work on for 3 weeks to slowly ‘bump’ it back into place while decreasing the inflammation and getting the muscles to relax at the same time. She’ll stay on Rimadyl for now and we added a muscle relaxant too. She’s already on good Omega-3’s and we will talk about adding something like Adequan or Pentaussie for long term maintenance.

She had laser therapy on the gluteal muscle and the right side of the SI, and I’ll have her regular vet do acupuncture in those areas. Had I known about the spondylosis before the surgery, I would have never chosen to repair the ACL surgically. But you know…hindsight and all that crap. The spondylosis is a long-term problem, and one that may prevent her from ever going back to agility or mountain hiking. I don’t want to think about all that just now. Instead, I’m just going to focus on how much she can progress in next 3 weeks. Heal Holly…heal.