This morning when I went downstairs, I was greeted with the familiar sight of my dog, Comet, sleeping in her bed in the living room. She was sleeping upstairs with me in the summer, in a second dog bed on my floor, but since retiring the air conditioner for the winter, she has to stay downstairs. The air conditioning unit that I run on summer and autumn nights drowns out any noises she makes, so her presence doesn’t disrupt my sleep. Because of my chronic insomnia and the fact that I’m one of the lightest, finickiest sleepers, we can’t afford the risk that her various noises and movements will rouse me in my quieter winter room. She usually gets up a couple of times per night, shakes her head, which audibly flaps her ears like flags whipping in the wind, and she rearranges her bed, circles it to make a nest and lies down. Sometimes, she also makes a clicking noise with her mouth or little yips as she dreams. Objectively, none of these noises are loud, and the loud hum of the air conditioner easily covers them, except when the condenser shuts off. In the winter, I just use two fans, which are significantly less effective at masking other noises. Accordingly, she wakes me up (if I’m not already awake) every time she moves or produces a sound. I do miss her company, even if it’s normally indirect anyway from her position on the floor.
This morning, I headed downstairs at my usual time (3:30am). Even though it’s Saturday, I maintain the same sleep schedule. Ben is sound asleep at this time every morning, so I carefully tiptoe around and illuminate my path withheld glow of my cellphone screen until I get to the living room at the back of the house where, from his bedroom, he is oblivious to any lights. I kneel down and kiss Comet, and cover her with her blanket if it’s fallen off. She loves to be warm, and our house drops to 50 overnight, so she appreciates being fully tucked in. Normally, she pays me little attention as I begin my meditation and morning routine. She loves to sleep.
This morning, she seemed excited and uncharacteristically energetic for 3:30. She came and sat next to me on the floor, leering over my supine body. I pet her head and she lay down next to me, curling into the side of my body. I let her stay there while I meditated, as it was comforting, and I started thinking about her mind and wondering what sort of thoughts she has and what is the extent of the complexity of her thinking.
The leg injury Comet incurred two weeks ago is a torn CCL, which is the dog analog of the human ACL, an important ligament that provides lateral support to the knee. Many people, and dogs, under surgical reconstruction to repair the ligament because full thickness tears will not heal on their own. Ligaments are notoriously poor at healing due to their avascular nature, and full thickness tears will not auto-repair because there are no fibers remaining intact to adjoin the two ripped sides. Comet has not had radiographic or nuclear imaging on her knee, so we aren’t sure to what extent the ligament is torn. Even if it is a full thickness tear, surgery is not always indicated, as many factors come into play with the decision including the dog’s size, age, weight, and general health. Not all dogs can handle the invasiveness if the procedure and the difficult rehabilitation process. Another practical factor is cost; an operation of this type will be several thousand dollars. We aren’t in a position to afford that type of expense because it’s considered an elective, rather than urgent, procedure even if she’s deemed a good surgical candidate. That is to say that she doesn’t need to undergo surgery, even if she has a full tear, to remain healthy and alive. Instead, the surgical repair will potentially restore the athletic and mobility functions of the dog prior to the injury. Dogs that do not undergo the surgical repair for one reason or another will not die or experience declining health outside of the limitations they will maintain in their gait and activity. For example, some will always have a limp, and if this significantly limits their ability to exercise, they can incur issues of inactivity like weight gain.
In the absence of diagnostic imaging to definitively indicate the grade of tear to Comet’s CCL, only clinical speculation can be made. With this consideration, it seems unlikely that her injury completely ruptured the ligament based on the mechanism of injury, her symptom presentation, and clinical testing. That means that there are likely still some fibers if the ligament in tact holding the ligament together. It can be visualized as a frayed rope rather than a completely severed one. Again, in humans and dogs, because of the inherently poor healing potential of ligaments, some partial tears are also surgically repaired because an artificial sewing of the ligament back together, even with the post-operative rehabilitation time, is still faster and more reliably effective than waiting for the natural healing. However, in most cases, a dog with a partial CCL tear will eventually return to full functional ability because the ligament will heal with time and proper rest. It is important to respect the needs of the body to heal, which means limiting physical activity and weight-bearing on the limb. The general consensus around veterinarians seems to be that this natural process takes 8-12 weeks, depending on the severity of the injury, the dog’s age and breed, and the overall health of the dog. Over the period of two-to-three months for healing, the initial pronounced limp of the dog should become subtler and he or she will start returning to their healthy gait and movement patterns. If, after the twelve weeks the dog continues to withhold bearing weight on the affected limb or refuses to walk, surgery is necessary.
We are in the wait-and-see 8-12-week window. We are two weeks in and she is still limping. She will gingerly put her foot down and partially weight bear when she is moseying slowly around the house, and she lifts it completely when she runs. We are strictly limiting her permissible activity so that if it’s partially tore, she doesn’t further damage it, which is a very frequent complication. That’s why rest and minimal use of the limb is so important. Any missteps or directional changes while the limb is planted on the ground can rupture the fragility of the remaining intact ligamentous fibers.
Even immediately after the injury occurred, Comet acted totally normal. She displayed no signs of distress and besides her constant limp, she continued to want to play, run, walk, and jump as normal. Outside, she still hunted squirrels with her usual primal, laser-focused drive and chased after them with an exuberant three-legged run. Although theoretically she can’t injure the leg if she has it tucked up under her torso and doesn’t bear down on it, it’s risky to let her run around with freedom because she does put it down in the lulls between spotting “prey,” and may inadvertently push down on it when she’s distracted from the discomfort and weakness by the allure of the chase.
Because we really cannot afford to offer her the surgical repair, full tear or not, we don’t want to risk escalating her tear, which is likely partial thickness (which should heal on its own in time), to a full thickness injury. This means that we are adhering to the conservative guidelines that reduce all activity to as little as possible. She no longer gets to come on walks or can be let off the leash in the yard to play and chase animals. Her only permissible mobility is walking around the house from room to room and short leashed walks outside to meet her elimination needs. As I’ve mentioned, I greatly miss her company in walks and I truly empathize with her movement restrictions because of all of the major musculoskeletal injuries I’ve suffered over the years. It can be so frustrating and boring to be cooped up inside and unable to exercise or play.
As she lay next to me this morning, I wondered how much she thinks about the fact that she hasn’t gone on walks with me. Does she know why she’s not coming? Does she understand that she has an injury? Can she interpret my explanation when she eagerly stands at the door when I’m about to go out telling her she can’t come because of her leg and then I touch it? Does she think I’m mad at her or don’t love her?
I imagine that she doesn’t have the cognitive ability to understand that because she is injured, she cannot come. I highly doubt she has the complexity of thoughts that would be required to understand that “when your leg is healed, you will come” and that “I miss you!” I tend to assume that a dog’s brain is mostly capable of thoughts pertaining to immediate needs and primal drives. She can clearly learn some basic commands and is remarkably in tune with our routine and her participation in it (when she will eat, when it’s a walk she normally comes on, when it’s the time in the afternoon that I invite her up on the couch to cuddle, etc.). She can clearly learn patterns and she definitely pays attention to us and her potential involvement with us. She knows a fair number of words and seems to understand human emotions (happiness, excitement, anxiety, anger, fear, sadness, etc.) because she responds differently and appropriately (and amazingly sympathetically and supportively to each!). Beyond that though, it’s hard to know what she thinks about when she’s lying there relaxing, what crosses her mind when she’s begging me to take her on a walk in her injured state and I turn her down for her own benefit, and what she actually thinks when she sees me display an emotion to which she responds (if I cry and she comes over, if I’m cheering and jumping and she jumps and wags too, if I’m pacing and nervous and she follows each step and leans into me).
I wish I could convey to her, in no uncertain terms, how much I love her and care about her. I use those words all the time and vocalize this to her, but I imagine the actual words are meaningless but that she knows they are true based on how I treat her and how safe and loved she feels. I don’t want her to feel sad and left out while she’s in this rehabilitation phase of her ligament tear. I wish I could impress upon her that she’s done nothing wrong and that it’s because I love her so much and want her to feel better that I must leave her at home. It breaks my heart to think she’s worried that she’s in trouble or not my friend so I’m going on without her. In the absence of the mental ability to comprehend my language or for her to grasp that she’s hurt and needs to heal over time, I hope that I can at least put any worries or feelings of doubt about my love to rest by showing more demonstratively how much I love her and care about her. If that means extra snuggle time and cuddles, I’m more than happy to open myself up to that! She’s a great dog, a respected third member of our little triad, and if I had the money, I’d jump on the surgery to return her to fighting form as quickly as possible. Because that’s not a viable choice for us, I will hope and pray that she heals physically on her own and doesn’t suffer any emotional pain during this long-term stretch of limited activity. Thankfully, she doesn’t appear to be in any pain, so that removes the very real negative affect that imposes on mood and happiness (in humans at least). I’ll try to keep her spirits up by involving her in more in-home activities, and shower her with even more demonstrative gestures of love. Maybe I’ll even make concessions for her to sleep in my room…