Aidi wan n'Eezel: the loyal azawakh

Broken Metatarsals 

Radiograph of broken metatarsals.

In one way Tawzalt’s foot wasn’t as bad as the image above. Only the inner two metatarsals were broken and displaced. The outer two were just cracked. In other ways, it was worse. Her fractures were caused by twisting her foot against the boards which acted like a vice. The fractures were very close to the distal (toward the toes and away from the hock) ends of the metatarsal bones. As a 13-week old puppy her bones were actively growing and bones grow from the “growth plates” on the ends. The fractures, particularly the displaced fractures on the inner two bones were very close to the growth plates.

First Aid

There was no question of mistaking that Tawzalt had a serious injury. Her screams were continuous and blood curdling. She was holding her rear leg higher than her head . At first, I was her hip was dislocated. It took me a while to locate her foot as the source of the problem. She helped me out by biting me repeatedly when I got close to where it hurt.

Unlike the image above, two of the bones remained somewhat structurally viable so the foot was not crumpled. Instead there was a large lump above the knuckles. My first thought was that the foot was badly bruised. Certainly Azelouan has screamed and wailed over whacking his toes when leaping over a log and been fine a few minutes later. My initial treatment was an ice pack.

I realized pretty quickly that the pain was not declining and the swelling was growing despite the ice pack. We had to take her to the vet.

Triage

 Our veterinary hospital is open 24x7x365. The only time I can remember when it was closed was when a hurricane knocked out all power in that part of northwest DC for a week. Unfortunately, if you don’t have an appointment you have to wait. I was a Sunday night. The last time I brought a dog in on a weekend night without an appointment, I waited for four hours. This time, despite a waiting room full of sick animals, the wait was about 30 seconds. The triage nurse took one look at Tawzalt’s foot and whisked her into the back for X-Rays and a healthy slug of morphine.

They have an electronic radiographmachine, so the X-Ray pictures were up on a computer monitor just a few minutes later. I don’t have copies of those pictures, but scroll back up in this post and imagine it with a puppy foot. If the mental image is horrifying then you’re pretty close to the mark.

Call in the Specialist

The on-call doctor that night was not a stranger. She had seen Tawzaltbefore and was very taken with her. I knew we were in trouble when I saw the blanched look on her face and she kept wringing her hands. It’s not good when the doctor is freaked out.

With an adult coursing dog, this sort of injury usually requires a surgical repair. They open up the foot and set the bones and fix them in place with temporary bone plates. The bone plate are removed in a second surgery 4 to 5 weeks after the first one. The foot is immobilizedin a splint for a total of about 8 weeks. The problem with Tawzalt was twofold:

• Because she was 13-week puppy her bones were very small – think pencil thin. They weren’t thick enough to affix a bone screw.
• The fractures were unusually close to the distal end of two of the bones where they had already likely disturbed the growth plate. Any surgery in the area would injure the growth plate further.

I was starting to think that Tawzalt would never walk on this foot again.

The doctor decided that she wasn’t comfortable treating this injury without consultation with a specialist. She called a guy named Tommy Walker. Dr. Walker taught neurology and surgery at the University of Tennessee for 12 years. He was a referral specialist for the U.C. Davis School of Veterinary Medicine and he co-developed a knee ligament repair surgery. He’s the go-to guy for the tough surgical cases.

Dr. Walker got a call about 9pm on a Sunday night. He said to do nothing except put a compression bandage on the foot to reduce swelling. Emphatically, do no surgery! He would make a special trip in on Monday to work on her foot.

There was nothing more to be done. I had to leave her there. She was whacked out on morphine and feeling pretty good. I found out later that the vet techs took it in turns to hold her in their laps all night. She never went into a cage.

Dr. Walker called me in the morning and said that he didn’t want to do surgery. He had looked at the radiographs and he wanted to set the bones under general anesthesia and then splint the foot for a month. It’s a remarkable thing when a surgeon recommends not to do surgery. His main concern was that we minimize additional trauma to the growth plates. The problem with this approach was that there would be no bone plates to stabilize the bones – which makes it critical to immobilize the dog. Dr. Walker was emphatic that she must not move for the first three days and then she needed to be on crate rest for a month.

Immobilize a puppy for a month.

“This is a coursing dogs, right?” he asked.

“Yes.”

If I did my part and kept her still while she healed, he said, then he was virtually certain that she would heal and eventually be able to run as though it never happened.

A month.

Tawzalt on "crate rest" in my office chair.

The Longest Month

If you have ever raised a puppy, then you know that at about two months of age they really start to explore the world. They do not sit still.

Oh, I almost forgot. The splint can never get wet. If it gets wet, I must take her to the hospital to have it changed immediately. I must cover the splint with a rig made from  a used IV bag in order to keep it dry when she goes out to the bathroom. She must never be off-lead. She must never run. Bathroom business only and then back to crate rest. The splints have to be changed twice weekly in order to accomodate her growth and to keep the foot from festering.

For the next three days, I held Tawzalt in my lap. When it was time for her to go out and eliminate, I had to first put on the bag. It went pretty well because she enjoyed the attention and her foot hurt like hell.

We went back to the hospital on third day for a change of splint and X-Rays. The good news was that the foot had set with the bones in perfect alignment. She should heal as long as I kept her still. Only 26 days to go.

No Really, Keep the Splint Dry

The splint was a real set-back for potty training. Tawzalthated to squat with a giant club dangling from her leg. She had accidents. On about the 6th or 7th day, she climbed onto the dog bed and peed all over it and her bandage. Well, she had an appointment for the next day to have the bandage changed anyway. We didn’t take her in “immediately”. How critical could it be?

Critical.

By the next day when her bandage was changed they said it looked like the bandage had been soaked with urine and she had a sore starting. The team cleaned her up and put on a new bandage. It took an exorbitant amount of time and I am convinced that the whole team of techs would keep her back there so that they could all hold her. She was becoming the hospital mascot.

Three days later, her bandage was due for another change. It seemed like she had managed to get it wet again but I couldn’t figure out how. The bandage stank.

It turned out that she had not wetted herself again. The bandage was soaked through from the inside. The wetness and smell were coming from  pus from a skin infection caused by the original soaking incident. Now she needed antibiotics and her bandage needed to be changed every other day. We still had three weeks to go.

After a near infinity of bandage changes, the foot infection  healed and we were able to luxuriate in mere twice-weekly bandage changes.

Broken puppy digging a hole (note the dry-bag).

As time went by it became impossible to immobilize Tawzalt. If I crated her, she immediately urinated all over her bandage. If I turned my back on her she ran around. One time, about three weeks into the ordeal, I left her quietly asleep on the couch so that I could take Azelouan for a potty break around the house. When I came back 5 minutes later, she leaped over the couch to greet me. I then learned from my wife that she had just run up and down the stairs, circumnavigated the house in a blur and hurled herself back onto the couch just in time to leap over the back of the couch when I opened the door.

I had visions of her snapping her foot right off and she still had 10 days to go.

Moment of Horror

The day finally came when Tawzalt was supposed to have her bandage removed, provided the X-Rays showed that her bones had healed. Dr. Walker’s assistant took Tawzalt in the back for her radiographs while I paced in the waiting room. After what seemed like an eternity of waiting, Dr. Walker called me into an exam room. He wanted to talk to me without Tawzalt.

Why didn’t they just bring her out to me? My stomach sank with the certain dread that her foot had healed crooked and she would be crippled for life.

“Her bones are healed!” Dr. Walker said as he closed the door. “Now, she has to heal the soft tissues which is much slower. You’ll have to do physical therapy with her every day.”

They showed me the radiographs of her foot. It looked a little bit wadded up because they X-Rayed her with the splint on her foot, but I could see that all of the metatarsals had healed and were straight. The only clue they had ever been broken was the slightest hint of a shadow on the innermost one. They taught me about the physical therapy:

• Slow-walking her on lead to encourage her to use the foot
• Stretching the digits to loosen up the tendons
• Deep massage to loosen the adhesions

Dr. Walker said that it would take not less than two more months before her foot was any semblance of normal.

Then they brought me Tawzalt. She was very happy to see me and to have the weight off the end of her leg. I’m glad that they went through everything with me before they brought her out because at the end of her leg was a twisted flipper. The foot was turned in pidgeon-toed almost a full 90 degrees. There was no arch. The two inner toes whose growth plates had been disturbed were tiny – like they had not grown at all. The two outer toes were huge by comparison but twisted from being imobilized in the splint so that the pads pointed toward the other toes rather than the ground.

Horrifying.

It was nearly impossible to believe that she would ever be able to use that foot again.

She hopped on three legs with me to the car.

The Long Road to Recovery

It’s easy to think of the body as a superstructure of bones with flesh over them, like the Terminator. We think of the bones as holding everything up. It isn’t like that at all. The bones provide superstructure but the tension of the muscles and tendons holds everything up, like a suspension bridge. Imagine the Golden Gate Bridge. If you loosened all the wires holding it up, the thing would collapse in a heap. That’s the situtaion with Tawzalt’s foot. There was no muscle tone whatsoever in her whole leg, from the tip of her toes to her hip. Even her loin on the right side was atrophied.

Over the next week, the arch in her foot returned somewhat so that it didn’t hang so alarmingly at a right angle. I would dutifully shuffle along with her on-lead at a pace where she would use her injured foot a little bit. I do her physical therapy stretches and massage twice a day. Things improved day by day.

It’s been about 6 weeks since the splint was removed. We hit a big milestonthis week. First time, she has enough strength so that she is standing up on her toes rather than having them splay out and flop around while she walks. She’s stopped tripping over her toes and skipping.

She’s not fully recovered, yet. Her right leg has about half of the muscle mass of the left leg. When she runs down stairs, she tends to hold her right leg in the air and just use only the left one as she learned to do when in the splint. The inner two toes are growing but are about 3mm shorter than outer two, which gives the illusion that her foot is pidgeon-toed. I think those toes are slowly catching up or maybe it is just that as the whole foot grows the loss of a few millimeters of growth becomes less important.

The most important thing is that Tawzalt can run. She loves to run. I think in 6 or 8 weeks it may be impossible to tell that she was ever injured.

Yesterday she almost caught a squirrel.

It was a very good day.

Tawzalt hurtling through tall grass.