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Cinder's Journey: Recovering From Metacarpal Fractures, Weeks 0-3

When we first learned that Cinder's paw was fractured, I immediately took to Google. A consummate worrier, I just needed to research every aspect of canine metacarpal fractures so I could emotionally prepare myself for what we had in store in the coming weeks. Knowledge is power, right? And power makes me feel safe. Turns out, the internet has an absolute dearth of information about healing these types of injuries. Frustrated beyond measure, I spent many nights lying in bed reading snippets from canine orthopedic journals in hopes that something will help me understand if Cinder would ever make a full recovery. Most of these nights involved a lot of tears and insomnia and were often accompanied by a somewhat debilitating sense of contrition. I still blame myself for what happened and I occasionally find myself silently praying to whatever gods may or may not exist that we'll one day be able to hit the trails again—pain-free and with the radiant joyfulness Cinder brings to everything she does.

This blog post is part 1 of a series I'm writing about what her particular journey has looked like in hopes it is helpful to anyone who is unfortunate enough to find themselves in this situation with their beloved fur children.

The Accident: On Sunday, January 3, 2021, Cinder was stepped on by my young horse, Mia, in the arena. Normally, she is very good at following the "no dogs in the arena" rule but I can only guess that she saw Mia's boisterousness as a threat to me and she ran in to interfere/protect me. I missed the actual event since my back was turned but Mia was in motion (trotting) and I heard a shrill yelp and Cinder went barreling out of the arena on 3 legs. At first I thought she was maybe overreacting but, with the help of a friend, I managed to move her into the barn where I sat her on a bale of hay and looked over her paw. There was a tiny skin abrasion but no other signs of trauma and, although she was non weight-bearing, I assumed that she had simply sprained it. I drove her home as a precaution and when she was still non weight-bearing at home, I lightly wrapped it with vet wrap for support and called the emergency vet. Since COVID was still wrecking havoc, the wait time for the ER was 8+ hours so, after asking questions about the injury, the nurse advised that we try to get her in to our regular vet the following morning. Luckily, we have an emergency Rx for carprofen on-hand so we gave her some to help get through the night. I slept on the floor next to her and hoped she would be fine when we woke up.

The next morning, she was still very uncomfortable and there was some noticeable swelling in her paw. We were able to get her in for an appointment with the vet that afternoon so we kept her quiet and as comfortable as possible while we waited.

The Diagnosis: Cinder is NOT the easiest patient. Fortunately she is muzzle-trained (amazing training resource here) but she does require sedation for anything remotely invasive. We sedated her upon arrival and upon palpation, our vet commented on the extensiveness of the swelling and noted that things felt "crunchy" (this is not a word I ever hope to hear again in reference to the physical state of any being I love). We sent her in for radiographs and it was determined that she had broken 3 of 4 metacarpals. Luckily 1 of the bones was acting as an internal splint but because of the number of fractures and the fact that they were displaced, the rads were sent off to an orthopedist. In short, we were pretty devastated by the news but the initial timeline we were given was 6-8 weeks in a splint which meant that we might get to ski as a family before the spring season was over.

Waiting on the Surgeon: Turns out that surgeons are really busy. Despite follow-up from C's care team, we didn't hear anything until Friday. In that time, I was a complete mess. Having been intimately involved in equine vet med for my entire life, I was used to get answers back within a day or two at the most so waiting 4+ days to find out if Cinder was a surgery candidate was physically painful. When we finally got the call from our vet with the new POC based on surgeon feedback, I ended up crying on the phone (this is something I try to never do with vets since letting my emotions take over makes it more challenging for me to have an informative conversation). The surgeon did not feel that Cinder would need surgery to achieve a full recovery but he did say that the timeline for healing would be significantly longer than we'd originally estimated: 10-12 weeks in a splint was the new conservative estimate. Because there is limited vasculature and muscle tissue at the distal end of the limb, these fractures have reduced circulation. Reduced circulation = longer healing time. This was another blow to my delicately reinforced psyche and it took me some time to make my peace with lengthy restructuring of our lives. The upside, however, was that no surgery means shorter healing time and less of a chance of complication due to infection and no scar tissue introduction at the surgery site. These were the positives I chose to focus on.

The Plan: At 4 weeks, we would do progress radiographs to check alignment of the displaced fractures. During those 4 weeks, C would have weekly splint changes to check for swelling/hot spots/to clean the small dressing on the abrasion she received during the accident. We were given a stronger Rx of Carprofen for pain + inflammation and a Rx for gabapentin and trazodone to help keep her craycrayness under control. From there, it would simply be a matter of keeping her busy brain occupied so she didn't combust.

Pet Insurance: This is a short and sweet ode to the magnificence of pet insurance but let me tell you, it is well worth the annual money. This would be a phenomenally expensive ordeal without it. It means that we can easily say “yes” to any emergency visits and bonus radiographs without much thought. I can’t thank our fabulous vet enough for recommending that we insure our little adventure dog!

Complication #1: 6 days after Cinder's first splint went on, it fell off. I came home from visiting horses and noticed that the top of the splint looked a little wobbly. Further examination revealed that it was *barely* staying on her leg so we called the vet to try to get her in for a new one ASAP. Fortunately, our care team is amazing and they were able to get her in—just in time, too, since the splint fell off in the car during the drive over to the clinic! A quick examination of her splint revealed that she had been secretly licking all of the adhesive off of the top bandage and, with inflammation down significantly thanks to drugs, rest, and support, there was nothing holding it on anymore. C got a shiny new splint that day and got a matching neck donut for nighttime since she'd proven that she could not be trusted with her own health and safety!

General Life: This has been the biggest adjustment for all 3 of us (4 if you count Fitzgerald, Cinder's cat brother, who might be taking the loss of his playmate harder than anyone). First adjustment is simply managing C's basic needs. Her splint (which we call "stumpy") cannot get wet so before going outside to potty, we have to put a plastic covering on it (which we call "stumpy's jacket). We name things because Cinder learns words really quickly and managing her care is easier when she knows what's happening ("time to put on stumpy's jacket" and she knows we're going to lift her front end off the ground). This has made the whole process much less stressful for all of us. Next point is that in order to access our yard, we have to go up and down stairs. Stairs are a big no-no for her with the splint so we have to carry her up and down them to get into the grass. Imagine doing this if you lived in an apartment! 3-4 times/day, we put on stumpy's jacket and take C outside to go potty or to just get some fresh air. It's a process that we eventually learned to manage on our own but for a while, it was very much a 2-person affair. Cinder's lack of mobility and general exuberance also means that she can't be left alone so Andy and I have weekly calendar exchanges where we decide who will be on Cinder Duty each day so we can each have something resembling a normal life. Right now I am incredibly thankful that we taught her the word "help" when she was small because she's so used to being carried that, even though she's 40lbs, she's at least relatively manageable for us.

Over the next few weeks, we borrowed a wagon from a friend so we could take C on "walks" around the neighborhood which was equal parts adorable and loud but it seemed to help keep her happy (ish). Car rides became part of the routine and we found reasons to go get gas or run errands that didn't involve leaving her alone in the car since she likes to leap into the front seats whenever we leave her alone. Otherwise, time went by without incident.

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