We are exchanging fun, fitness and rehabilitation Hydrotherapy sessions for your dog at Country Canines Hydrotherapy in pool or underwater treadmill as rewards for helping fund Lolee's orthopaedic surgeries with Prof. Noel Fitzpatrick at Fitzpatrick Referrals.
Lolee Bear has been fighting cardiac and multiple orthopaedic issues since She was 12 months old, She has been fully insured since birth, but due to all her issues and intervention needed, insurance hasn't been enough to fund this-Prof Noel Fitzpatrick gave her a chance that others couldn't.
12 GP vet consultations, 2 hospital referral consultations, 6 orthopaedic Noel Fitzpatrick consultations and 8 orthopaedic surgeries, 3 X-rays, 4 MRI scans, 3 CT scans,1 heart surgery, 3 echo dopplers & cardiology consultations and 3 stem cell therapies. 2 of the surgeries she has had are part of the One Health Initiative research and have never been done before but provided her with solutions where conventional surgery couldn't!
Here is how it started:
Lolee presented with intermittent left hind lameness after exercise and on turning and an unusually elevated heart rate and panting for long periods of time after exercise, when it is warm and when She was stressed.
Lolee visited 2 primary care vets whom declared her as ‘sound’ on her health checks. There was no luxation or movement in her stifle detected on palpation or any tibial thrust detected. However, these tests are always more difficult to do on a giant breed. Despite daily conservative management in underwater treadmill and pool as well as on lead short walks, Lolee’s lameness continued- so an x-ray was done of her left stifle not long past her 1st birthday, which showed arthritis in the form of medial buttressing, indicating a suspected cranial cruciate ligament tear (CCL tear).
Her BNP blood test, which measures the level of heart disease was elevated and an x-ray was done of her chest which showed slight enlargement of her heart; so we were referred over to our first Veterinary hospital locally, the surgeon wanted to do an arthroscope (which is a camera inserted into the joint) and then a TPLO (tibial plateau leveling oesteotomy) on her for a cranial cruciate ligament tear without any further tests or scans-but I wasn’t keen on an this going ahead without a CT or MRI ruling things out first.
Lola had an echo doppler done by a Cardiologist at the same hospital whom detected a patent ductus arteriosis (PDA), which is a congenital defect where a small duct hasn’t closed at birth so it allows blood to flow through the wrong wayl She was also diagnosed with pre-clinical mitrial valve disease. We had the option of a PDA surgical closure, but were advised to have Lola’s lameness addressed first.
Following this conclusion We obtained a referral to our second orthopaedic surgeon at a different hospital whom undertook an MRI of Lola’s stifle which shockingly showed up an absence of a left lateral trochleal ridge (the ridge that keeps the knee cap from moving around). The surgeon believed this had been caused by a fracture as the other stifle was ‘intact’. I know Newfie pups are a wobbly bundle of fluff and get up to all sorts but I struggled to think of an incident that has caused such a trauma to her left stifle. I was ever so careful in the first 12 months of Lolee’s life; no stairs, no unnecessary impact on her joints, restricted lead walks, pool hydrotherapy and non-impact agility which involved board walks, pole work weaves, tunnels and cavaletti poles which improved her flight arcs, ataxia and proprioception which all helped to stabilise her growing joints and acted as a form of fun physiotherapy for her. She had been on joint supplements since birth and received a balanced diet.
Not having come across a case like this before, the Orthopaedic Surgeon sort advice from collegues and discussed Lola’s case with Cardiologists. The consensus was to operate on the stifle before the heart due to the catastrophic risk of infection if done the other way around. Eventually Our surgeon suggested referring us onto Noel Fitzpatrick for a custom fit implant-we appreciated the honestly of the team and were ready to face our next chapter.
We waited a tentative 3 months to see Noel Fitzpatrick, whom CT scanned Lolee to diagnose congenital lateral patella luxation on the left stifle. We agreed to proceed with a never-done-before custom fit trochlear ridge titanium replacement to the lateral left stifle. Previously only whole trochlear ridge replacements have been done, but Lolee’s other ridge was intact so there was no point in breaking up an intact bone. At this point Lolee’s (CCL) cranial cruciate ligamament was completely intact which was reassuring.
As time went on and we waiting for the custom implant to be manufactured, I noticed Lolee was starting to struggle on her left fore leg and became increasingly ‘pigeon toed’ and head nodding, so when we went down for the stifle surgery I brought this up with Noel-whom on palpation detected no reaction in any range of motion of elbows or shoulders on either forelimb…but we all know how stoic these Newfies are so I asked for a CT scan of all forelimb joints whilst She was under for her stifle surgery. Due to Lolee’s heart condition, She was assigned an Anaesthetist to keep tabs on her heart through the surgery as this increased the risk.
We had a call just before midnight to say the surgery was ‘challenging’ but ‘successful’ and her heart coped well. Lola had a titanium trochlear lateral ridge replaced on her left stifle- unfortunately her CCL ligament had partially ruptured by the time She went under for surgery so She also had a TPLO (tibial plateau leveling oesteotomy) surgery which involved breaking into the bone, changing the angle of the stifle and placing a plate to stabilise the cruciate; her femur had to be pinned to realign as it had twisted with the abnormal loading over time and She had a biceps tendon release procedure on both elbows as mild and moderate elbow dysplasia (medial coronoid disease) was detected. Lastly She had a arthroscope of both shoulders which detected osteochondritis dissecans (OCD) on the caudo-central humerous, with a worse lesion on the left shoulder requiring more surgical intervention in the future, but, for now, a debridement of the cartilage had been done to help ease discomfort.
It was a bit of a shock the amount of surgery Lola had gone through and what pain She had been putting up with, but we think She didn’t really know a life without pain as these conditions were congenital or developmental from a young age and She was in good hands.
For 3 months Lola couldn’t walk unaided and was on forelimb and hindlimb support harnesses where we had to follow her everywhere. It was the most difficult few months we had ever been through. At first She wouldn’t step out the front door for fear, She developed a seroma not far off the size of a football on her stifle-even Noel said they had not seen one that size. Overtime She started to walk properly and wanted to bear weight on her stifle which was encouraging. 5 months later She would still hold it up or go lame now and again despite intensive rehabilitation; She had underwater treadmill therapy from 2 ½ weeks post operation and pool therapy 3 months post operation nearly every day as well as physiotherapy in the form of daily passive range of motion, ice and cold therapy, massage, weight shifting, lasering, kineseo tape, EMS muscle stimming to help maintain and build her muscle as She wasn’t walking and acupuncture and biomagnetic therapy weekly. At this point I had been spending 3 hours a day rehabbing Lolee’s left stifle-I could see little improvements week by week which kept us all positive and moving forward, there was signs of hope everyday.
2 months in Lolee needed heart surgery and had her PDA closed by an ACDO device that was put through her femoral artery into the PDA gap in her heart, where it will stay and the heart muscle will form around it and close it up. Straight after her heart surgery her heart was re-echoed and immediately the size of her chamber walls had decreased. This was a real turning point in Lolee’s recovery; once her PDA had been closed She was livelier, walking better and more confident-it really was lovely to see her like this after the hard couple of months after the initial orthopaedic surgeries. We were starting to smile!
I wanted to do more to ensure that Lolee’s ‘not as bad’ joints were going to be okay, as we were doing so much to help her other joints, I worried that the stress and strain on the ‘better’ joints would take its toll, so 3 months after Lola’s stifle surgery She had stem cells that were taken from her own adipose tissue and grown in a laboratory and injected into her right shoulder and both her left and right elbows to help conservatively manage these conditions.
6 months after the initial orthopaedic surgery, Lolee was eventually strong enough on her left stifle to undergo OCD shoulder surgery. Due to Lolee’s young age and giant size Noel was concerned that the standard surgery that He currently does would not be sufficient for Lolee at this point so we had telephone conversation after telephone conversation, mainly with me asking for more information and research about a new method of OCD surgery that had, again, never been done before that Noel proposed-it’s research so far was outstanding which used Lolee’s own body to regenerate and heal itself and provided biologic solutions rather than a synthetic alternative. The surgery was successful and She was trying to break out the hospital kennel 2 days after the surgery so we drove the 8 hour journey through the night to bring her home. She is a different girl to whom we have known the last year-She is full of life and wanting to play. Her pain medications play a big role in keeping her comfortable at the moment, but we hope with perseverance, careful management and daily hydrotherapy She will be able to cope without these in the future. It is still early days in her rehabilitation and we have a long way to go. We both look forward to enjoying our lives again, getting out and about, water training, swimming, walking and generally being a happy team! She deserves some fun after all this!
Lolee has been part of some amazing new ground-breaking research into advancing surgeries for animals and people alike and we hope She will help provide better and alternative solutions for animals and people alike in the future.
Lolee is a very lucky Newf as She has access to her own canine rehabilitation centre that We just opened as She fell ill, which is one of our decisions as to why we choose to go ahead to help her with surgery the best we could-her success is down to 50 % surgery and 50 % rehabilitation- we couldn’t have done it without water! We also think careful management and hydrotherapy from the moment we got her, kept these conditions from causing so many problems earlier on.
It is down to the Newfoundland’s stoicity, determination (and stubbornness), perseverance and strong will that has got Lolee through all this. She has never once given up and has the been the one whom has kept us all going!
It has been a long and difficult journey … and there is a long road ahead, especially building her confidence back up around other dogs, but I know with Lola’s happy courage & zest for life, we will be okay! We have so much to look forward to with our Lolee Bear and the best years are yet to come & I have a feeling She is going to make up for it!
Follow our progress on Facebook @loleesjourney