Cinder's Journey: Recovering From Metacarpal Fractures, Weeks 4-8
Post diagnosis, the first few weeks went by without incident (read about weeks 0-4 here). Our weekly splint changes were stressful for Cinder, who was becoming less and less of a fan of visiting the clinic and was requiring a gabbapentin-trazadone cocktail to keep her anxiety under control. Fortunately, our vet team was amazing and did everything they could to ease her stress during these visits.
Week 4 Radiographs: The surgeon had indicated that we should do radiographs at week 4 just to check for proper healing alignment. So, we did weekly splint changes for these first 4 weeks and then brought Cinder in for these progress rads. Hopeful that somehow she would be the anomaly that healed in 8-10 weeks, my anxiety was coupled with high expectations heading into this appointment. Those hopes came crashing down when we got the opinion back from the radiologist: the fractures weren't showing many indications of healing and, after 4 weeks, this was very concerning. As we've said before, Cinder is a super athlete. She can run 25 miles without batting an eye, has skied the SW Chutes on Mount Adams, and is a skilled rock scrambler (which is terrifying). Seeing no signs of healing and poor alignment after FOUR WHOLE WEEKS was enough to knock me on my ass and make me believe that she would either end up being a surgery candidate (cue a restart of the healing timeline) or would never move without limping again. Our vet sent the rads off to the surgeon immediately and I was once again thrust into the internet world, hunting down healing timelines and example radiographs that might make me feel better. Again, I found nothing and was forced to wait.
I'm not the type of person who can just accept second-hand information. With the issues we'd had getting prompt answers from the surgeon our care team had been consulting with, I was beside myself with worry when we'd gotten the opinion from our vet and the radiologist. After several days, we finally heard back from the surgeon. He said everything looked fine and he was pleased with her progress. He indicated that, at this stage, we wouldn't expect to see changes on the rads because she would have fibrous callus formation, rather than bony callus formation, which does not appear on rads. My initial thought was "okay, wtf?" because we'd just had two opinions, one from our vet and one from our radiologist, that indicated that things were NOT looking good. Our vet expressed that she has a very high regard for the opinion of this particular surgeon but that she would understand if we wanted a second opinion. She sent over a list of clarifying questions and reiterated that Cinder is a "super athlete" and he still seemed to believe that the alignment was looking good at this stage...
I went on the warpath and called almost every specialist in the portland metro area. Some were horrifically unhelpful (Sunstone Veterinary Specialist refused to consult directly with me unless I made an appt—first available was 6 weeks out—despite my having all of Cinder's medical Hx and radiographs on-hand, and wanted to only speak directly with our vet); some were great (Cascade Veterinary Referral Center immediately forwarded my request and Cinder's rads along to their team and got back to me with an opinion, should we need surgery). I'm not on a vendetta against these unhelpful clinics but I do think it's important to note who is worth contacting when you're in a bind and who deem themselves above taking 10 minutes out of their day to speak with concerned owners who are willing to pay for their opinion. I didn't expect free advice; I expected professionalism and a basic level of care for a highly involved owner. I needed to talk to a human being so I could get my questions answered in real time.
Second Opinion: A friend of ours in Bend has been incredibly supportive through this whole process. He cares a lot about Cinder and has been checking in on her regularly since the accident. His dad is actually a retired vet and he has been acting as a go-between for us with him, getting an outside opinion when we've gotten radiographs. When he found out that we were working with multiple contrary opinions, he put us in touch with his vet, High Desert Veterinary Hospital, who immediately took down Cinder's info and sent it off to Dr. Anthony Oddo. Like MAGIC, I received a call from Dr. Oddo within an hour of my emailing over her Hx and radiographs. Dr. Oddo has treated metacarpal fractures from crush injuries exactly like Cinder's, he has a deep understanding of the Border Collie nature (aka, she needs to make a full recovery), and is a very skilled surgeon. He answered all of our questions and let us know that he feels like Cinder is currently on the path to making a full recovery. I cannot thank Dr. Oddo enough for his amazing compassion and for allowing us to bombard him with questions for 20 minutes.
With a second opinion in our pockets, we decided to stay the course. We would re-radiograph at 10 weeks and splint changes could now take place every 10ish days, rather than every week, which would be a hugely beneficial change for our entire family.
Occupying the Border Collie: I joined a Canine Enrichment group on facebook in an effort to get ideas on how to keep C's busy brain happy. One of the biggest things I've taken away is a how-to on introducing Scent Work to her. I've toyed with one day possibly volunteering with SAR and Andy and I have discussed taking C through an avalanche rescue course at some point so getting going with scent work has been a great stepping stone toward reaching either of those goals. And she loves it. I actually had to take a big step backward because she would get soooo excited when she "targeted" the smell that she'd slam her stump down on whatever towel/container/vessel was containing the item she was "finding." I think at this point we've reached the highest level we can reach with her limited mobility but it's been a really fun exercise. It has has the side effect of making her nose more active, however, and now she's obsessed with smelling every object that comes into our home haha!
I used the below resources for training guidance:
* I used lavender and ginger essential oil because I did not have birch oil on hand.
K9 Sport Sack: So.... I started following an aussie puppy on instagram after my friend Suzi sent me a link to the account—the poor thing had sustained a metacarpal fracture in 2020 after an incident at the dog park. As I dove into the profile, I came across a photo of the pup being carted around in a backpack that was made for dogs. Fortunately, the photo had a tag and I started researching the K9 Sport Sack. The cool design was originally made for city commuters who needed to find ways to take their dogs on public transport but they'd adapted it to suit larger dog breeds and to be comfortable enough for humans that they could give their dogs a ride while biking or hiking. With arm holes and a super secure fastener, it would be a great way to get outside for "walks" with Cinder while she is less mobile than normal. The packs were even designed in consultation with vets! I sent a link to our vet team, got the green light, and ordered one! For the first few weeks, Cinder LOVED it. She would immediately get so pumped when we would leave the driveway and at one point, Andy even carted her around the barn with it. It was awesome... and then she did her border collie thing and decided she hated it. I'm pretty sure she probably got a bit of hair snagged on something and is now certain that the pack is going to kill her. So we've spent a number of weeks slowly reintroducing the concept of the pack to her. I think it will ultimately give us a means of transport for late season family ski tours: we skin up with Cinder on a leash and then toss her in the pack for the ski down (since running downhill will likely be the very last thing she's allowed to do). All in all, I've been excited about the design and can't wait to try it out more on future outings.
The Broken Splint + Bonus Rads: Two days before Cinder's week 7 splint change, she broke her splint right above her fracture site.... this was likely due to her incredible penchant for slamming her stump down on the ground whenever she gets excited (yet another reason why she cannot be left alone for even a moment). Woof. Immediately panicking (okay, I panicked and tried not to), Andy made a wood + athletic tape splint support and I called the vet to see if we could get her in that same day for a change. Luckily, again a HUGE thank you to our vet team, we were able to get her in on a few hours later. The team thought it was best to get some extra rads done that day just to make sure the broken splint hadn't rearranged anything or caused any injuries to the fracture site. The resulting radiographs showed a massive improvement in healing:
LOOK AT THAT CALLUS FORMATION and the amazing alignment changes (at least in the top down view!!!!)... I still thought the lateral view was stressful but I'm not a vet or a radiologist so I just tried to let it all go). What a fantastic day this was. Everything else continued to look very good and we had no issues with hot spots aside from a minor one on the back of one paw pad. There also continued to be very limited irritation at the top of the bandage, which can be a big problem area in some dogs. Clearly, our team needs us to buy them all a beer or an orange juice when we're through with all of this nonsense!
Cooperative Care: As I've said many, many times now, all of these visits to the clinic that involved being poked and prodded without her explicit consent (Cinder's least favorite, even with her human family). In another incredible move by our vet team, we were advised to start doing some Cooperative Care training with her at home. The whole point of CC is to reduce stress and increase Cinder's participation in her care with the caveat being that she'll be able to opt out of the activity. There are a lot of resources about Cooperative Care but we've chosen the path of the chin rest—Cinder is invited to "rest" her chin on my lap and I/we/someone "bothers" her (this includes touching her paws, grooming her, "poking" her with a needle-less syringe, etc.). If she picks up her chin, the "bothering" stops and she's invited to rest her chin again and the cycle repeats. This has made a HUGE difference in her willingness to participate in routine care activities, like grooming, which is her absolute least favorite thing in the entire world. Despite incredibly careful grooming practice with her from the time she was 12 weeks old, she's always hated brushes and has been known to run and hide when she hears me brushing my hair (I swear to the gods that nothing bad has ever happened to her, she's just a sensitive flower).
Anyway, I am a firm believer in this method of training and recommend that anyone with pets should check it out.