Caudal Articular Process Dysplasia - Lily's Journey (Part 2 - Surgery) by Ann-Marie Fleming

22 January, 2017


This is a continuation of Lily's journey as we work towards treating her ongoing mobility issues. Lily is my senior pug (11 yrs) who was diagnosed with Caudal Articular Process Dysplasia which is the root of her mobility problems. I describe this in greater detail in Part 1 - Symptoms & Diagnosis The article below recaps all that happened with her surgery.

It felt like Lily's surgery would never come. We were originally scheduled for the procedure in mid-December. We drove the 6 hours to reach the vet hospital (Canada West Veterinarian Specialists in Burnaby, British Columbia). We went down one day early to have a urinalysis done since Lily started to have difficulty urinating and her neurologist Dr. Sharp was worried that she may have an infection and if so we would need to postpone surgery. So we did the test Wednesday evening and I brought Lily back Thursday morning. The results from the urinalysis showed no bacteria so the surgery was a go. 

I checked Lily in, paid and even had my panic attack over Lily going through such a long and invasive procedure only to be told an hour later by Dr. Sharp that he had a family situation happen and that he could not do the surgery because he could not focus enough. Given how challenging the surgery would be, while shocked at this turn of events, I appreciated his honesty since I wanted him on his 'A' game. 

3D Model of Lily's Vertebrae

The silver lining in all of this is that it gave Dr. Sharp time to use the very cool 3D model of Lily's spine to give me a visual of what the surgery would entail. I have to say the model looks way bigger in the photo than in real life. In fact it's quite tiny which made the procedure even scarier since there really isn't much bone to work with. The surgery itself would involve the securing of two metal plates into her T11 and T12 vertebrae using four very tiny screws. She also needed to have her herniated disc that was compressing her spinal cord repaired. This herniation is the result of having too much movement in her vertebrae for so many years, something the plates are going to prevent moving forward. 

He showed me where the plates would be placed and he even showed me his practice holes for the screws. This 3D model is amazing because it gives him so much more visibility into Lily's vertebrae than he could ever have during surgery and a chance to practice so he gets the placement of the screws and plates exactly right. I love technology! He explained that he was going to sterilize it so he could bring it into surgery with him and use it as a guide. The biggest risk of this surgery surrounds the placement of the screws. If they are not precisely placed then the plates would not be as stable and we may not have the long term benefits we are looking for.

The surgery was then rescheduled for January 12th. Everything about this day felt better than the last attempt. Lily ate much better this trip, the weather was nicer, the hospital seemed more organized, there were no worries about infection and I felt much more confident - this was the day. I dropped her off at 8:30am and then had to wait for a call to let me know when they would be starting the surgery. The procedure itself would take about 6 hours which is terrifying. Of the 6 hours roughly 4-5 would be on the plates itself and then the disc repair was something that would go very quickly since Dr. Sharp has done this many many times. Lily is only the third dog that has had this plate surgery done by Dr. Sharp at Canada West since it is such a new procedure. 

I received the call at about 10:30am from Dr. Sharp telling me they were about to begin. I felt instantly nauseous. I knew in my heart that this was the right thing to do for the long term health and quality of life of Lily, but all I kept thinking about was how Lily would feel when she woke up confused about what just happened. Anyways it was happening and now I had the excruciating task of waiting 6 hours to find out 1) if Lily was ok and 2) if the procedure was a success. The one thing that had me very hopeful was that Lily had been under anesthesia twice in the last 12 months, including about 3 hours for all the diagnostics done for this condition and both times woke up like a champ, so of all my dogs I knew she would do well even with being under for so long.

Caudal Articular Process Dysplasis - Plate placement CT scanThursday truly felt like the longest day of my life. As each hour passed I kept trying to picture what they were doing to her. And then finally I received the call from Dr. Sharp. My heart sank as I answered the phone. Within seconds of saying hello he explained that the surgery went extremely well and that it's the best he's done this surgery to-date. I could hear the smile on his face and I felt like the luckiest mom alive. He said the screws were placed in an excellent position, right down the ideal bone corridor. This was later confirmed through a CT scan shown here. He then asked me if I wanted to hear something funny - I said ok. Well apparently Lily's 3D model melted when they tried to sterilize it so he didn't end up having that as a tool. So glad he told me this afterwards! 

He was also successful in removing the disc material that was compressing her spinal cord by performing small corpectomy/mini-hemilaminectomies on both sides just over the T11/12 interspace. The CT image here shows her spinal cord uncompressed as a result of this disc repair.CT Scan of Lily's T11 corridor - uncompressed

I then received another call a few minutes later that Lily once again woke up like a champ and was doing well. That's my girl!

I was not able to see her that night, but was able to visit her the next day. Apparently Lily would not stop barking in her kennel until someone sat with her so they made a bed for her under their desks so she would not feel alone. This blew me away and when I visited her I could see how much everyone cared. They were so sweet to her and everyone took a moment to tell me how great she's doing. Canada West is a very special place!


Lily Right After Surgery for Caudal Articular Process DysplasiaRight after the surgery Lily was still feisty, but was unable to walk on her own so they needed to use a rear sling to support her rear legs. She still managed to motor down the hallway to see me though and the tech had a hard time keeping up! She was moving her legs well, but was severely knuckling which is why she needed the extra support. This was a little shocking to see since she was now worse than when she went in, but because of the inflammation from the surgery and the shock to the system from having such a major procedure performed, the body needs time to adjust. Lily stayed in the hospital for 3 nights to give her enough time to regain some of her strength and to ensure that there were no complications and I was able to pick her up Sunday morning. When I picked her up she still needed the support of the rear sling, but by the next morning had improved so much that she was walking on her own again.

I brought my girl home and for the first two weeks she is on restricted exercise so I have her spending most of her time in my bedroom. We were given a set of range-of-motion exercises to do 3 times a day plus pain medication taken every 8 hours. I am also doing cold compression several times a day to help with her healing. We are one week into her recovery and she is making me so proud. She is still not back to her old self, but is sure on the road to recovery. Dr. Sharp told me that it would realistically take 6-12 weeks for her to show improvement from the surgery, so we have a long way to go.

I will write another update on Lily's recovery as we work through the next several months, but overall Dr. Sharp has done everything possible to give Lily the best chance of improving or at the very least at preventing further decline and I will be forever grateful. It is now up to Lily to take it from here and me to help her gain back as much strength as possible so we can take full advantage of this impressive procedure. I am hoping that Lily will be a posterchild for this procedure and given how strong her spirit is, I am extremely optimistic that she will exceed all expectations! There is no keeping this little pug down :)

 Ann-Marie Fleming is the Founder & CEO of Dog Quality, a provider of products focused on improving the quality of life for older dogs.

 

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