Comet’s ACL Surgery Post-Op Day 1 and Night 2

I’m tired both from playing dog nurse and from sleeping poorly as dog mom.  Yesterday had its trying moments, but I think Comet and I worked well together as a united team with a common goal and communicated about as well as can possibly be expected from an interspieces pair.

The biggest challenges were faced in the morning. Comet was completely unable or unwilling to try and get up. When I would hoist her out of her bed, lift her up, and position her limbs under her to encourage her to stand, she’d wilt over like a heavy rag doll, relying solely on my arms under her body. Even though she has three strong, healthy limbs, she reacted as if all four were rendered totally useless. I carried her like an infant outside to see if she would pee, but she recoiled her limbs even more dramatically, tucking them up tightly against her torso. I’m sure the rain and sopping wet grass made for undesirable footing, but she clearly wasn’t going to try to pee and I wasn’t that interested in being urinated on anyway, since my arms will supporting her. I brought her back to bed, trip unsuccessful.

At that point, I decided to review the discharge paperwork and rehab instructions yet another time to verify that she was expected to be up and walking at least three times for 5-10 minutes that first day. After confirming these guidelines, I called her surgeon and left a message, explaining Comet’s refusal to even stand three-legged on her good legs.

The surgical nurse called me back a bit later and asserted that Comet should definitely be up and moving some. She told me to massage her back and hips because it’s common for dogs to be very stiff after the prolonged awkward positioning from surgery and sleep. This seemed like a reasonable explanation because Comet certainly slept in an unusual position that whole first night without moving an inch. The nurse also suggested luring her with food and treats, goading her to take a step for each morsel. It should be noted that dogs don’t have to bear weight on the repaired leg (they can hop or toe-touch down), but if they want to, it’s actually safe. I read lots of dog ACL repair resources beforehand and the degree to which the rehab protocol was restrictive or permissive varied greatly. Our surgical nurse said it’s actually ideal if they start touching it to the ground at least, rather than fully retract it up by the body, because it helps reprogram the neuromuscular patterns involved in using that leg. Because she’s been injured so many months now, Comet has become accustomed to not allowing that limb to be involved in her gait. This disuse not only causes the muscles to atrophy, but also engrains faulty movement mechanics (the habit of only three-legged ambulation). Therefore, ideally, she’ll start dropping that repaired leg down and tentatively putting a bit of weight on it as soon as possible.

All of this sounds reasonable, yet was so far beyond the realm of what we were dealing with since Comet wouldn’t even use her normal limbs. The surgical nurse warned that if Comet wouldn’t resume at least her limping walk after a good massage and treat-motivation to move, she would have to come back in to be checked if there was some other issue going on, such as a nerve block or problem from the procedure. At that alarm, I must admit my heart rate kicked up a few notches, since it would be difficult for me to drive her all the way to the hospital alone. That said, I certainly could, and would, if that was what was necessary. After confirming that I was following the correct medication regime so that her pain level shouldn’t be debilitating (if I was under-medicating her for example, she might have been in too much distress to tolerate standing up on even her good limbs), the nurse wished me luck and told me to call back in an hour with the outcome.

I got to work. I heated her back and hips with the heating pad and then massaged her shoulders, back, and hips for twenty minutes. I’ve got to say, that’s a surprisingly long time when your patient is a slightly nervous dog. After all that, I got wet dog food, something Comet never gets, but that clearly enticed her. I’ve rarely seen her perk up so dramatically with just a little taste. After she sampled the metaphorical “carrot,” I carefully helped her up and tried positioning her limbs to hold her own weight. She collapsed down into my arms again, but after some encouragement, several progressively more successful attempts, and wet food, she stood. It was a relief she was sturdy enough on her own because I was so excited and proud of her that I withdrew my arms from under her body and cheered!

My celebration seemed to further strengthen and invigorate her, as she started slowly gimping towards the dollops of wet food I was placing on plates all around the downstairs. It became a game and soon we were both genuinely having fun! Comet was only using her three healthy legs and had her repaired leg tucked up, but I already knew this was acceptable. After a few minutes of being up and moving about, I helped her back outside. We have two stairs to the front door, so I carried her down. Although she blinked irritably in the rainy morning standing there motionless at first, I eventually coaxed her over to her favorite patch of grass where she peed. This felt like a triumph as well since the discharge paperwork indicated it might take two days to see urinary function return. I helped her back inside and dried her with a clean towel. Deciding to push my luck just a bit more, I offered water and gently urged her to drink. She obliged and lapped up a lot in Comet terms, since she’s rarely much of a drinker. Maybe the wet food was salty! After all that action, I tucked her back into bed and put a cool pack on her leg for ten minutes.

The ease of mobility gradually improved over the day and we stopped using the crate all together. I inquired if this was a safe option when I called the surgical nurse back with the report of Comet’s success getting up. She said a crate is only necessary in cases where the dog wants to be jumping up onto or off furniture or may engage in other such vigorous actions. Because it took all of my long-rehearsed personal trainer cheerleader skills to get her up at all, I knew this wasn’t a possibility. Comet also is not the type to jump or run randomly around the house anyway, so for now, she’s just in her bed on the floor. If and when there’s any reason to suspect she might be feeling well enough to pose a risk for overdoing the activity on her leg, she’ll go in the crate when she’s not on the leash or engaged in rehab on the floor with me. As it is, she already needs help into and out of her little bed on the rug because it has a four inch wall around it to cradle her body and she seems unable to figure out how to lift her legs to get in, even though the walls are soft and mostly collapsed anyway.

I had a minor heart attack in the afternoon after noticing an incompatibility with the written medication dispensing directions and the actual medication in the bottle. Comet was prescribed 100mg pills of gabapentin that, according to the paperwork, were to be taken 2-3 at a time (for a total of 200-300mg per dose) every eight hours, so up to 900mg per day. However, they actually dispensed 300mg capsules, which means she should have only been taking one pill every eight hours to reach that 900mg per day amount. Instead, she was getting three times that dosage! I panicked and called the animal hospital. They were closed but I was told by the answering service that the medication is totally safe and doesn’t affect her liver or kidneys. While 900mg at a time was excessive compared to what she needed, I was assured she wasn’t harmed at all, but that the surgeon would call first thing in the morning (and indeed I received a call at 7am confirming zero negative repercussions for the incorrect instructions). I was told that gabapentin is sedating and often given in even higher doses for old dogs in chronic pain to help them sleep. I guess that’s why poor little Comet was so limp and groggy in the morning when she was just a rag doll unable to stand! She was probably barely conscious!

Last night, after discovering this potential error, I decided to give her just the one pill, not the 2-3 as indicated in the instructions, because after Google-image searching the pills in her vial, I was confident I was holding 300mg capsules and not 100mg ones.

Unfortunately, I’m not sure whether due to withdrawal effects or just the much-reduced dose allowing her to finally feel a more accurate magnitude of the pain, but Comet was not feeling well overnight. I was up in bed an hour or two when I started hearing her whimpering downstairs. I got up and went to check on her. She was persistently whimpering and nearly hyperventilating, breathing rapidly and shallowly. I dove into my knees beside her, adrenaline coursing through me from the fear that something was terribly wrong. Ultimately, I think she was just anxious and in pain (or withdrawing) because as soon as I lay next to her and started petting her, she relaxed and stopped crying. Despite being exhausted, I sat with her for thirty minutes ago and pet her head and neck. Eventually, she seemed lulled to sleep so I quietly got up to go back upstairs. As soon as I was halfway through the kitchen, the whimpering ensued in full force so I went upstairs to grab my pillow and blanket so I could sleep on the couch right above her bed. When I got back downstairs from that quick trip, she was hyperventilating again. After again sitting with her and stroking her ears, she quieted, and I made my way to the couch, which turned out to be an unacceptable compromise in Comet’s mind. She wanted her mama to lie right next to her on the floor and hold her close. And so I did. As I told my mom this morning on the phone, I got a taste of what it must be like for “real moms” (with human children) when their child is very sick. I remember a few nights as a young girl where I’d go to my parents’ room crying after throwing up everywhere or otherwise quite sick and Mom would not only clean me up and take care of me but also “sleep” next to me on my rug, though I’m sure little sleep occurred.

I ended up watching TV most of the night and cuddling Comet with her back up along my body. She even insisted on lifting her head out of her bed and sharing my pillow. There was hardly an urge to feel frustrated that I couldn’t sleep because she was so endearingly sweet and reliant on my love for comfort. I know that Comet loves me, yet it’s usually less blatant. It kind of made me feel good to be needed and useful as a pacifying agent for my little girl.

She slept lightly most of the night and kept reopening her eyes when I’d trail off on the petting and try to get some rest myself. After nearly a full season of “Spring Baking Championships” watched, it was morning and time for me to get up anyway and get ready for my day. I called Ben who was soundly asleep in a quaint and comfortable hotel home in Newport to report about our night and then took Comet outside. She’s moving a bit better already this morning and she seems totally normal in terms of her anxiety, breathing, and lack of wintering. She received her appropriate dose at 5am, so hopefully last night was just a difficult night transitioning off the unintentionally high dose. My mom, who prescribes medications like gabapentin as part of her profession, confirmed that withdrawal symptoms are a real thing with this medication, which is why it’s usually tapered. My poor little baby.

Understandably, I’m tired and a little sore this morning from the sleepless night on the uncomfortable floor. I’m sure my discomfort is nothing compared to Comet’s though, so I’ve got nothing to complain about. I’m thrilled that today is slated to be warm and sunny because I think it will make it easier to get her outside for her quick rehab walks. I think the hardest parts are behind us and this process will continue to go more smoothly.

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