Wednesday, June 3, 2015

Kenai: The Surgery Saga

I last wrote about Kenai in April. Since that time, at least on the blog, there has been quite the radio silence about him.

In this case, no news was NOT good news. Not in the slightest.


On April 15, 2015, Kenai underwent tibial tuberosity advancement (TTA) surgery and meniscus repair (removal) on his right stifle at Virginia Tech VA-MD Teaching Hospital. This surgery was necessary because of the pain caused by the torn meniscus and the failure of the lateral suture from the bilateral stifle surgery he'd received in 2013. This second surgery came after nearly 5 months of conservative care (crate rest and no exercise) to try to remedy the issue.

So, for Kenai's right stifle, this April surgery marked it's second surgery in less than two years. Kenai was 3 years old for his first surgery and five years old for his second. He is very young to be having such complications! He is at a good weight (noted by multiple vets), on a good diet (approved by multiple vets), and has a healthy, active lifestyle (as noted by multiple vets).

The second surgery in April went well. The only complications noted were hemorrhaging around the knee during surgery, slower than normal clotting time, and observation that the bone around the surgery site seemed abnormally soft. Tests were run and cultures were grown to try and answer these abnormalities. All tests and bloodwork returned normal though (they also ran a blood panel pre-surgery that was normal), and the cultures came back negative*.

*The first two cultures were negative, but the later they grew, one became positive from the old appliance in the leg - removed during the newer surgery for placement of new appliance. Vet reported that I shouldn't be concerned about this and it likely did not affect anything.

I brought Kenai home two days post-op and began the crate rest and rehab schedule as outlined by the VATech folks. All was well.

Until it wasn't...

A Third Surgery

On April 24 Kenai experienced an appliance failure; a failure of the TTA surgery.

To the best of my reckoning, it occurred during one of our rehab walks. He had been very "up", as a horse on stall rest may be, resembling a kite on a string. I had the leash as short as it could be and he was RIGHT beside me. My hand held the leash mere inches above his collar. Despite this, he jumped a small bit in such a manner to swing his rear end away from me in one fluid motion. It didn't seem like much at the time, but I suspect this must have been the motion that caused it as there simply was NOT anything else that had occurred where he may have overly stressed the leg.

On Saturday morning, April 25, Kenai was 3-legged lame again. He refused to use the leg. He seemed happy otherwise.

Monday, we headed to my local vet to see what was amiss as Kenai had not improved at all. X-rays were taken. The appliance looked good on initial viewing, though the vet (the newest to the staff) noted that the tibial crest did look a bit abnormal, but she would have to double-check with the head vet as she was not as familiar with TTA's. The x-rays were sent to the vet who did the surgery at VA Tech, as well. The recommendation from my local folks was to keep him on strict crate rest without the rehab schedule for a week and restart the NSAIDs which had ended over the weekend.

Three days later, April 30, the vet who performed the surgery called me with bad news. She'd reviewed the x-rays and it appeared that Kenai had experienced a failure. The tibial crest was fractured. She warned that more surgery may be necessary if the bone continued to move. She advised that I keep Kenai on strict crate rest and keep him as quiet as possible for a week. If the bone didn't move, then more surgery could be avoided. I would need to get follow up x-rays the next week to see where the bone was.

I unfortunately received this call when Kenai and I were 3 hours from home en route to crew for a rider at the FEI trials at the Biltmore. I had his crate and had been as cautious as possible with his every movement, but still, the situation wasn't ideal. Kenai was walked exclusively with the sling through the weekend, was kept in a small crated area in the back of Mary's trailer away from the hubbub, and was only out of his crate to go potty over the weekend. Other than some whining, he was remarkably calm and quiet all weekend. He was a great patient. I got him home as fast as possible as soon as my crewing duties were over and all seemed well.

At the x-ray on Tuesday, May 5, I was on pins and needles. The news that the surgery had failed was hard enough to stomach. The waiting time for the x-rays to develop to find out whether or not another (what would be Kenai's third surgery on this stifle) was needed was nearly impossible to bear. To the outsider, I'm sure I seemed calm, but internally I was a mess.

When the vet came back with the x-rays and put them up next to the ones from the previous week, the verdict was clear even to my untrained eye. The bone had moved. A lot. The implant was pulling out of his bone. The line of screws placed for the appliance was slowly fracturing the bone and shearing it away from where it should be.

April 27: Note the shard of bone pointing downward
that is in from of the left most side of the plate;
Note the location of all the screws and their

May 5: Note the progression/separation of the shard of bone
It is much more obvious now than on April 27;
Note the position of the top two screws; their angles
are vastly different from the April 27 image

My heart and stomach were in my throat as I choked out the words, "Fuck." Tears welled up in my eyes as I struggled to find the words to form a coherent sentence. The vet looked at me with more empathy than I could have ever imagined. Her look said it all. "Do you want a hug?" she asked, "You look like you really need a hug." Silent tears fell down my face as she gave me a big embrace.

I wiped my eyes afterwards, my voice a little more sure of itself. "Will you send them to Tech?" She nodded confirmation. More trivial talk occurred, but I don't remember it. I do remember asking them if they could just bill me later, I wanted to get Kenai - who was stressed for the first time about being at the vet - out of there. They agreed, expressed their sympathies again, and I headed out the door.

Anecdote: I'd planned to run errands with my afternoon no matter the news. For those who curse the process of getting a new cell phone and upping your contract and all the time it takes, I say this to you: Go in right after you receive horrible news. When the sales clerk asks the question they [should] always ask as you enter, "Hello! How are you?" and you start silently crying in front of them, I guarantee they will get the process over with as quick as possible! I upped my contract and got a new phone and was out of the store in under 15 minutes.

Wednesday morning (May 6), as I was about to head into the field for work, I received a call from VATech. The doctor who had done the original surgery had reviewed the x-rays and wanted me to come down that day or the next day for more surgery. By the time I received this call, I'd had time to pull myself together. I played hardball and asked concise questions demanding some answers on the spot. I inquired about possible options and I noted that I simply did NOT have the money to drop on another $3k+ surgery. The vet told me they might be able to absolve some of the cost, she would check and get back to me.

Surprisingly, she got back to me in < 30 minutes. She'd spoken to the head of the program, the assistant chief of staff, and he said they had some teaching money available. They could absolve me of all of the cost of the third surgery except for $400-500. That would be cheaper than the cheapest surgical option - amputation. And thus, an appointment was made for 1p the following day with plans for Kenai to go into surgery the morning of May 8.

Unlike the first time I drove down to VATech for the surgery and sat around teleworking and fretting about how Kenai was, I decided I would do things differently this time for my own sanity. I planned to drop Kenai off and then head to the New River Gorge (NRG) to climb for the weekend. The NRG isn't very far from Blacksburg and it would make more sense to go there and busy myself with activity and good company than to sit anxiously in Blacksburg or drive home.

When I dropped Kenai off, the original doctor he had and the assistant chief received me. They took Kenai back and then the asst. chief came back out to talk to me. He explained that he has seen failures of TTA before. They're not common, but when you do enough of them (as this hospital does) you do eventually see failures. He explained and drew out for me what they would do to fix it**. He explained that as with any procedure, there is possibility for things to go wrong. Medicine isn't always an exact or precise science, a fact I'm well aware of coming from a family with many medical professionals. He said it was unfortunate that the failure had occurred, but confirmed that he's never had the repair surgery he was going to perform on Kenai fail. He also noted that if I didn't have bad luck I wouldn't have any luck.

**If anyone would like more details on this, I'm happy to tell you individually. I'm not going to get to technical within the telling of the story.

I shared that I would be at the NRG until Kenai was ready to go. He gave me the option of Saturday or Sunday for pickup and I told him Sunday, remembering how long Kenai had been in the hospital for observation after his first stint down there. I wanted him to receive the best care possible for as long as possible and thought this was prudent. The asst. chief told me I could pick him up between 8a and 9a on Sunday morning and then sent me on my way, not making me wait for them to do follow-up x-rays and exams to 110% confirm that the surgery was needed as they usually do. He knew my time was valuable and with a word of caution about the speed traps on the way to the NRG, he sent me on my way.

I spent my Thursday evening catching up with old friends. On Friday, I climbed at a new-to-me location and had a blast with friends new and old. I was relaxed and content knowing Kenai was in great care. The hospital called me with updates morning and night and immediately post-op. All was well, all went well. The only surgery complication this time was that Kenai was mildly hypothermic coming out of surgery so they put a Bair Hugger on him in ICU. Not a very great complication at all, IMHO.

Saturday was another outstanding day of climbing followed by beers at the lake. It was HOT. But the climbing was great, the company was better, and the combination of beer and that cool late at the end of the day was fabulous. I was as happy as I could possibly be all things considered!

But then (you knew there was a "but then.." coming), I received the evening call from the hospital.

A Fourth Surgery

Instead of a 4th year student on the line to talk to me (as per the norm) it was the doctor who had performed the original TTA surgery.

"Hello. This is Dr. _______ calling to update you on Kenai."
Great! How is he?
"Well, I'm afraid I have some bad news..."
*my stomach drops to China, I feel the blood leave my face, and I gesture for my climbing partner who is driving to pull off the highway NOW*
"...Kenai experienced a failure of the surgery today."

Immediate tears. Immediate feeling of being lost. Immediate feeling of no hope. Despair.

The vet noted that the asst. chief had never experienced/seen a failure of this surgery during his career. She noted that another surgery would be best to fix things. I asked about amputation. She didn't like that idea but said yes it could be done. I was a notch under hysterical (for me) about this time. I asked what would she do if it were her husky (knowing she had one). She said she'd do another surgery. I asked if I really had any choice. And she said something along the lines of no. I conceded to another surgery and ended the call. (For the record: she was as empathetic and sympathetic sounding as possible for a phone call.)

I sat in the car on the side of the road climbing while my climbing partner did his best to console me. He was outraged at it all. Less emotionally involved than I, he had his wits about him more and spouted off a few logical arguments in his anger. I calmed a bit as I listened and decided I would take his recommendation and call back with more questions about what the hell had happened and why and what could be done.

I called back and was patched through to the vet I'd just been on the phone with. The tears were gone and anger was present now. I pounded her with queries and demanded answers. I wasn't nice. I reigned myself in though and apologized before it got too bad and asked if I could talk to the asst. chief who had done the surgery (and would do the following). I told her I was sorry, I knew it wasn't on her, I didn't mean to spout off to her, but it was all very ridiculous that he'd had a failure IN THE HOSPITAL, and I needed more information and answers.

She was very understanding and got me through to the other doctor quickly.

I continued my angry tirade of questions that demanded answers with him. That didn't last long at all. He pushed right back and put me in my place FAST. I'd compare it to training a horse and teaching them to NOT do something - they make an error,  you put them in their place, and if you do it well enough and they're in the mind to learn/listen, they stay where they are and don't repeat the error. That vet put me in my place and I stayed there resolutely.

I was meek thereafter in our conversation. I got my answers and it seemed that a fourth surgery (third with VATech) was still the path to take. They'd be doing the same kind of thing they had done for the third surgery, but with slightly larger implants. The doc said he would call the team that night and see about getting them in the following (Sunday) morning. He then thanked me for being calm and shared that I actually handled it a lot better than most and did a much better job than he would have done himself in the same situation.

I cried awhile longer, unable to do much else. When we arrived back at the campsite to meet another friend to then go to dinner, I'd managed to stop crying. All of my actions and movements were one of an automaton. I felt empty and hopeless. I went through the motions of normalcy out of duty only.

I called my mom then and spoke to her for a time. As I talked, I wandered aimlessly away from the campsite and into the woods up the first path that presented itself. I paced for a time on the trail as I talked, and finally turned to see my climbing partner, worry and concern written across his face coming up the trail behind me. It's good he showed up, I'd likely have kept wandering mindlessly otherwise in my state of mind. He led me back to camp.

Right before we were getting into the car to head to dinner (which I insisted I must do; being around people would be good to get my mind off things), Saiph called me back. I'd tried to get up with her before my mom. I talked to her for a time and finally managed to calm down significantly. It was good to hear her take on all things considering her expertise in the field of vet med. She's also one of my absolute best friends and therefore has a knack for understanding me and helping me through hard times.

At dinner, I ended up sitting beside a vet from WA. Go freaking figure. The climbing world is bizarre like that. Prior to finding out he was a vet, he asked me right as I sat down, "Sorry to hear about your dog. What's wrong exactly?" To which I gave him the biggest are-you-fucking-serious-right-now face. He then volleyed with, "Oh! I'm a vet by the way." My expression softened and I asked if he really wanted to know because it was kind of lengthy. He did. And thus I talked to him most of the evening. I didn't even order food or drink, my climbing partner - knowing me well - took care of all of that for me. <3

Right before the pizza arrived, I received another call from VATech which I stepped outside to take.

It was the asst. chief calling to let me know that the anesthesia team didn't consider the surgery life threatening enough to perform on a Sunday so they'd have to do it first thing Monday morning. I could understand that and told him as much, thanking him for being willing to do it on a Sunday nonetheless. I asked him a few more questions about what we could do to keep Kenai calm and maximize the likelihood of success querying about casting, splinting, sedation, etc. He noted that splinting the knee is difficult because you must stabilize the joints above and below - difficult when the above joint is the hip. I understood this as we employ the same type of methodology to care for patients with ski patrol. He said that they would send me home with sedatives to give him. (My home vet had already been texting me and said we'd do whatever we had to keep him calm with regards to sedatives, so it was good to hear the VATech vet confirm that sedatives were a good idea for a time.)

He also said they'd want me to pick him up the afternoon following surgery. Basically when the anesthesia had worn off completely I would come get him and take him home. Hopefully he would be calmer in my care than he'd been at the hospital. (Previously Kenai had not suffered great anxiety at the vet. But that was at home where he knew the vet and the techs because they're friends of mine with whom I interact with outside of our professional lives. With all that happened in the past month though, Kenai was distrusting vets more and more and had become quite stressed when at the vet's office.) I agree to this and said I would also make sure someone else could drive me down so that I could sit in the back with Kenai for the 4 hour drive home to help keep him calm. The asst. chief agreed this would be good, thanked me again for being so understanding and applauded my understanding of science/medicine and noted that it really helped to be able to talk things through with someone who had a grasp on what was going on.

I returned to dinner and made it through the rest of my evening without issue, though I still felt quite empty and hopeless.

Sunday morning I struck out for home. I was exceptionally sore from the previous two days of climbing. I cannot express how strange it was to come home without Kenai. To then spend the night in my own home without him was even stranger. I've been away from him certainly, but not at my own place of residence.

May 11, 2010
The following day, May 11, mom and I would travel to Blacksburg to pick Kenai up. The huge irony to this? This day was my 5 year anniversary having Kenai in my life; 5 years ago on this day mom and I traversed some of the very same roads to pick Kenai up from Lynchburg, VA.

My mom met me midday to drive to Blacksburg to bring Kenai home. We received a call from the hospital that the follow up surgery had gone well with no complication around 12:30p. We left right after that call and headed south, arriving at the hospital right around 5p after one stop to eat dinner.

We didn't have long to wait once we'd arrived. They brought Kenai right out.

I'm not going to lie. He looked rough. He was visibly happy to see me, but he wasn't all there. He had a lot of drugs in his system and was very likely in a fair bit of pain. I told him I was so so sorry, but we were going home now. I hadn't left him there for scientific testing like I'm sure he was convinced of by that time!

They briefed us on everything we'd need to do in the coming weeks, gave me his meds, and swept us out the door.

May 11, 2015; the blue is his wrapped up leg
Kenai was physically calm for the whole drive home. He sat up, but it was rare. He lay down nearly the whole time. I think if I hadn't been there to sit with him he'd have stood a lot, but fortunately, I was able to discourage that behavior. He was definitely having a BAD trip though, howling and whining intermittently in the oddest of ways (for him). The only thing that kept him quiet the last hour and a half of our journey was having his window down all the way so that, when lying, he could have his head out the window - even in the rain. He'd bring his head inside the car a for short bursts, scream a bit, then fling his nose back into the wind and be quiet. It seemed the wind in his face and the smells that forced their way into his nose were the only thing keeping him sane.

He peed a little when we got home before going into his crate for the night.

That first night SUCKED. So hard. I'd given him his first round of meds that evening to really try to dull the pain and help him rest. I don't know how much it helped. He stared off into the abyss and just whined and cried for most of the night. I might have gotten 3 hours of sleep, but it was likely closer to 2.

I darted into the office briefly Monday morning to grab things I needed to work from home, updating my coworkers VERY briefly on everything. I have the greatest supervisors ever who all but demanded I work from home for a few days to "keep an eye on the boy". Everyone in my office has a dog. Everyone understands how much Kenai means to me. I really couldn't ask for a better situation.

Back at home, I set myself up at my kitchen table and put Kenai in the crate in the front room to keep an eye on him and ensure that he knew I was still there and hadn't left him again. I worked and observed him as I went along. He was restless, to say the least. He couldn't get comfortable and was up and down and up and down every few minutes. I finally, conceded to put him in his crate in the bedroom because I thought he might like it more and then snuck in to peep at him every 15 minutes.

The first couple observations, Kenai was stress panting and staring glassy-eyed into the abyss. Around 10:15a though, there was a sharp change - he was finally sleeping for what was likely the first time since arriving home. I celebrated and sent a text to Karen and Saiph to update them. Saiph noted that it had been 24 hours since he had gone into surgery, so it was most probable that the drugs administered during surgery had finally worn off and he was now just on the medications I was administering. She shared they they can have a really bad trip from the combination of drugs. I believe it!

Kenai proceeded through the first week of rehab without any bobbles. Steady, marked improvement was evident each day. I walked him with the sling every day during this time.

Into the second week, I weaned him off walking with the sling little by little. He was probably ready sooner, but considering all that has happened, I wasn't taking chances! He continued along the path of steady, marked improvement with each passing day through week two and into and then through week three.

The Present

Kenai has been weaned from spending absolutely all of his time in a crate. He's still in there the vast majority of the time, but when I'm home for lunch and home in the evenings, I let him be near me off leash. I will often shorten the length of one of his rehab walks to allow for the little bit of walking around I'm beginning to allow him to do inside. This way, he isn't receiving an excess amount of exercise.

Not pictured: the chair to the right that I was
sitting in.
I feel comfortable doing this because I know very well how this dog's behaves at home. He doesn't run amok. He wants to be where I am and lie nearby. He may chew on a bone if it is available, otherwise he dozes on and off and just watches what I'm doing. He's calmer being able to be near me than he would be in his crate in another room. As he's built strength and is more likely to do something stupid in his crate protesting about being away from me, I've been more apt to let him be near me off leash.

I haven't been disappointed. Kenai seems to know what is expected of him. Even though the living room crate isn't up any more, he goes to that spot and lies down as soon as we come back in from our walks (slow timed walks for rehab that have steadily increased in their length since surgery) and lies down and stays there. In the past couple days, he has begun lying in slightly different areas, but he still comes in and settles quietly somewhere immediately and then doesn't move.

My local vet has seen him once so far and was very pleased. She said she can tell without x-rays that there is a lot of bone regeneration going on in that area. (Follow up radiographs will be taken a few more weeks from now.)

Unlike the first time we were down there for the TTA, I've only heard from the hospital one time (2 weeks post op) since our departure. After the level of communication from our first visit, I find this a little odd, but I'm over it.

I have been in contact with the closest professional canine rehabilitation specialist about physical therapy for Kenai. We are currently in the process of figuring out when will be best to begin the rehab. I anticipate a minimum of three sessions (so few due strictly to financial confinements) with a lot of homework in between.


It's been an absolutely nightmare getting to this point. Everyone who hears the story - vets especially - are shocked at how crazy this saga is and has been. Speculation on what may have caused it and what could have/should have been done differently have been discussed at length. (Weakened bone due to first lateral suture surgery; TPLO would have been better than TTA; TPLO should have been done instead of TTA due to history with lateral suture impacting the area already; should have kept him even more quiet than I did (nigh impossible); should have gone to a different vet; should have splinted/casted; should have had lesser intensity rehab for longer; etc.)

What is currently holding Kenai's leg together.

Yes, I've also spoken to Kenai's breeder about all of this. He is unaware of any other dog he's bred having issues like this - certainly someone may have and didn't contact him, he noted that, but to his knowledge there have been no issues. Kenai's father was castrated after Kenai's litter because the dogs didn't have the right "look" for showing. Kenai's mother has also since been spayed (reason not explicitly provided, but I have no reason to think it is for anything out of the ordinary). Kenai's breeder has always come across as very responsible to me. He replied to my email asking about potential issues with his dogs/litters within 3 hours of my sending it. He remembered who I was despite me not communicating with him in 3 years! He also gave a generous donation to Kenai's GoFundMe page which was very touching. I am incredibly grateful for this. I would (and likely will) absolutely get another husky from him.

Additionally, I've spoken to no fewer than 8 vets in some manner through the occurrence of all of these events. They're shocked and saddened by all that has happened. They acknowledge that've had a really tough go of it and it isn't a common thing. My local vet especially has been really outstanding through all of this. She knows it has been rough and crazy. She's been wonderful and involved for all of it and I really can't thank her enough.

Ultimately, it really seems to just boil down to really shitty luck. In the bell curve of the likelihood of happenings, I finally fell in that lower probability area. Shit just happens.

But I'm doing what I can to not dwell on it all - hence the radio silence on all things Kenai on social media. I don't want to speculate or dwell on what has happened. I have been and will continue to focus on the present, on what the facts are, what my observations on recovery have been, and do my best to keep the good going into our future.

I've got my dog still. I refuse to think on the future or speculate what may be or will be. We're taking things day by day, a walk at a time. My dog is happy. I am happy. That's all that really matters. <3

18 Days post-op
19 Days post-op

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