Under the Knife - My Elbow Dysplasia Surgery and Rehab

This is part 2 in a multi-part series covering my elbow dysplasia journey. Part 1 discussed how it was diagnosed and the specifics of my case. Upcoming Part 3 will cover the various interventions I continue to employ to stay active, and will be linked here once published.

Showing off the "turkey leg" look after my bilateral elbow surgery.

Just look at those poor little nakey elbows. 😭 This is a pretty far cry from how my pawrents had envisioned life for me as a 10-month old puppy, but it was my reality after undergoing surgery for my bilateral elbow dysplasia diagnosis.

Whether or not to pursue surgery was not an easy decision, especially given that by the time my surgery date approached, my limping was no longer visible. Unfortunately, none of the various elbow dysplasia surgeries can "fix" a dysplastic joint. They can clean up damaged bone/cartilage and in some cases will alter bone alignment to establish more favorable load mechanics, but in all cases arthritis is inevitable; the goal is simply to reduce pain and try to slow the progression of that arthritis. Studies that track long-term outcomes show mixed results; but existing studies comparing surgical vs. non-surgical approaches are very small and aren't controlled for numerous other factors that may influence outcomes over time - such as the dog's activity level, weight, and whether and what other interventions were used to manage arthritis. So without really solid large-scale studies evidencing a clear path forward, it was an agonizingly difficult call for my pawrents to put my young, energetic puppy self through an operation that would severely restrict my activities for months afterwards. But ultimately they felt that early intervention combined with long term maintenance would give me the best chances for an active future.

Depending on the specific type and severity of dysplasia that a pup has, there are a number of different surgical approaches that may be called for. Some of these are quite significant osteotomies that involve cutting and repositioning either the ulna or humerus bones in a way that either lessens the degree of incongruity in the joint, or else shifts the load within the joint onto a healthier surface.

In my case however the surgeons felt I wouldn't see enough benefit to justify one of these major osteotomies, and instead elected to perform a "Subtotal Coronoid Ostectomy" aka "Subtotal Coronoidectomy". As mentioned in Part 1 of this series, the CT scan showed fissures within my coronoid processes; this surgery cuts out and resurfaces the fissured areas to relieve pressure and prevent the damaged bone/cartilage from breaking off into fragments that will further erode cartilage.

Sometimes this is done as an open arthrotomy, but in my case they did the procedure arthroscopically, which left only a tiny incision and reduced the amount of trauma to the joint capsule.

Meanwhile, my pawrents had been reading more about stem cell therapy, and its potential for treating arthritic joints as well as other conditions. So when mom dropped me off at Animal Surgical Center for my appointment, she asked if they could also harvest adipose tissue from my abdomen for Vet Stem to process for stem cells while I was under. It meant an additional incision in my belly, but that way I wouldn't have to undergo yet another surgery/anesthesia event to harvest them and I could bank the stem cells if ever we wanted to try them in the future. These stem cell treatments have been a big part of my maintenance strategy and I'll talk about them in more detail in the upcoming part 3 of this serial post.

My recovery plan following surgery for the first 2 months was basically:

• I had to stay contained in a small area of the house, resting as much as possible.

• Leashed bathroom breaks only for the first 2 weeks.

• I had to wear a cone or donut until the incisions healed to prevent licking/infection.

• Starting at 2 weeks, I could do 5-10 minute slow leashed walkies.

• Each successive week, I could add up 5 minutes of walkie time as long as I didn't appear sore afterwards; if I did we had to back off and ramp up more slowly.

• At 2 weeks I could start doing very short weekly PT and hydrotherapy sessions.

• For at least 8 weeks no zoomies, jumping, or other vigorous activity and no stairs unless absolutely necessary.

• NSAID and Pain medication (Galliprant + Gabapentin) with a sedative (Trazodone) added on as needed. Dosing and frequency were able to taper off the further I was into recovery, and after the first couple of weeks they were no longer needed.

• Reduce calories to prevent weight gain due to inactivity.

Resting and recovering using my donut as a pillow, with a towel-wrapped ice pack on my elbow. You can also see my abdominal incision; this is where they harvested adipose tissue from which to extract stem cells.

Frozen meal in my Kong

My pawrents reconfigured the living room furniture to block out a small recovery space for me where I had views and easy access to the backyard through the sliding glass door, and they camped out downstairs with me at night since I couldn't go upstairs to sleep in the bedroom. I was very sore/lame for the first 5 days or so, after which I began rapidly improving. At that point, the challenge became keeping me - at the time a 10 month old puppy - entertained despite such limited physical activity. Instead of my regular meals, the majority of my food was given in the form of various snuffle mats, food puzzles, or frozen into Kongs to make it more time-consuming to eat. Unhappily my portions were also docked by about 30% to keep me from becoming chonky due to inactivity after the surgery 😡 This was a very unpopular move, but I will admit it worked as my weight remained stable.

Henlo smol fren

We also spent a lot of time just watching the backyard critters out of the window, and it was during this time that pawrents were able to train a little bit of prey drive control with my backyard gray squirrels. They know my pawrents keep a stash of nuts near the door, so they would always come up to the door and peek in. My pawrents used it as a training opportunity and I built a still-standing truce with my squirrel frens such that I never chase them and can even sniff them politely when they come for a nut. (This truce however does NOT extend to any other species of animal - or even any other species of squirrel.)

One silver lining of this all happening during Covid lockdown was that since everyone had to stay home anyway, I had one or both pawrents around to keep me company and entertain me at all times. For my part I behaved surprisingly well during my convalescence. I kept on smiling; all I really wanted was for one of my humans to be there with me giving me attention and reassurance. It showed my pawrents what a sweet, happy-natured pup I really am.

My first hydro session

Like most northern breed dogs, I am NOT a fan of baths (despite all the desensitization pawrents tried to do when I was a baby), so once my incisions were healed and I was cleared to start hydrotherapy, we weren't really sure how it would go. Mom wasn't allowed to enter the facility with me at that time given Covid protocols, but the tech sent pictures while she waited outside. As it turns out, I got the hang of it pretty quickly (lots of treats and verbal encouragement may have helped with that) and I only complained a little.

The first two weeks were the hardest but after that as my allowed walkie time gradually increased, my fur gradually grew back, and I built up muscle with hydrotherapy I was doing quite well! At my 8-week checkup post-surgery I was given the all-clear to start slowly and sensibly reintroducing more strenuous activities to get back to "normal". From then on my pawrents have focused on multi-modal maintenance therapies to keep me going strong - stay tuned for more on that in the upcoming part 3!