Stromboli Von Emrick (Stromboli)
Cranial Cruciate Disease - Stromboli's Story
by Jill McCarthy, Coral Springs, FL
Getting Stromboli from Tanya 5 years ago was one of the greatest days of our lives. He was fun, playful and very loving. Personally I was always a little dog type of person so I didn't know what to expect but when we got to Tanya's house and she said do you want to see you your baby and Stromboli was put into my arms, it was all over. We had driven from Coral Springs, Florida to Maryland to pick him up and for that trip home, he never moved from my lap. Kevin has accused me to this day of stealing HIS dog.Over the course of the last 5 years, we have had some minor Great Dane issues.
When he was a puppy, he had a case of the bloat after stealing a piece of pizza and we had a tiny issue with his ears getting infected but it was all a learning experience. Stromboli has never stopped being loved and spoiled from the second we picked him up. Back in September of 2008, we noticed that he increasing was having a difficult time sitting down and his leg was shaking. We asked our vet and Tanya and both sources stated that sometimes Great Danes simply have muscle spasms that cause their legs to shake. I kept getting nervous because this seemed to me like it was getting worse. Stromboli never stopped running to the door or running up the stairs so I thought it couldn’t be hurting him too bad until one Friday when he completely stopped using his left leg.
The door bell rang and he stayed lying on his bed and when he did get up and he kept it lifted in the air. I called the vet immediately that night and made an appointment for early that morning. Early Saturday morning we somehow got Stromboliup into our SUV. When we got him into the room, he weighed 170lbs. Our normal vet came into the room and started pressing around his leg and he didn’t seem to be responding anywhere she pressed. We finally laid him down as she pressed and pressed and pressed. Then as I got his attention on me, she pressed on that knee. He whipped his head back at her, as if to say OUCH that hurt and she said, “Yup, there is. I think it’s his knee. “ She told us she wanted to keep him to examine him more and the only way she could do that was to sedate him and run some x-rays. She said she thought he tore something and she would call us in a couple hours. We had no idea at that point, what we were in for. We went home and about 3 hours later, Dr. Jehn called us at our home. She told me that it was as she suspected that Stromboli had Canine Cranial Cruciate Disease which is similar to ACL injuries in people, but the process by which the tear occurs is different. Unlike in people, who primarily suffer from traumatic ACL injuries, the canine cruciate tears from a degenerative, inflammatory process which weakens the ligament.
Tearing of the weakened ligament may or may not be proceeded by a mild traumatic event (e.g. jumping off the couch). She said although Stromboli was not overweight, he was a big dog. She said there are several factors that may play a role in this inflammatory process including: being overweight, an excessive activity level, or poor joint conformation (the way the joint is formed during development). These factors can result in the initiation of the inflammatory process that weakens the ligament and leads to ligament tearing and destabilization of the stifle (knee) joint. The loss of joint stability in turn makes the inflammation worse resulting in a viscous cycle of joint damage which we refer to as degenerative joint disease (DJD) or arthritis. Now the main function of the cruciate ligament is to stabilize the joint in a front to back direction and prevent the femur (the thigh bone) from sliding backwards off the back of the tibia (the bone spanning between the knee and the ankle). This motion is known as the cranial drawer.Basically Stromboli had to have this fixed and the only way to have it fixed was major surgery.
I sat on the phone in disbelief. She said she wanted him to have a surgerical consult right away and being that he was so big and sedated, she recommended that we take him for that right now. I said, but where.She said right down the street to Coral Springs Animal Hospital. Then I thought to myself, but to what surgeon. She then said, my husband is a surgeon. Wow, what a relief. My biggest fear is to have someone I don't know doing major surgery on Stromboli. With that, Kevin and I jumped in our car and went to the vet. They had Stromboli laying out back sedated. He looked so sad. They put him on a stretcher in the SUV and I sat with him until we got him to the surgery center. When we got here, they had a team of guys come out and lift him onto another stretcher and put him into an elevator where they were going to have the other Dr. Jehn look at him. My eyes started tearing up. They brought us into some room where we waited. Finally after about 20 minutes, Mr./Dr. Jehn who we now know today very well came into the room. He commented on how beautiful and large Stromboli was and how well we took care of him. He explained what his wife did and drew us a diagram of what type of surgery Stromboli needed. He explained that he couldn’t just repair the ligament because Stromboli was just too big and it would just tear again. He said There are multiple components to treating cruciate tears including conservative (non-surgical) and surgical treatments. Conservative therapy is geared towards breaking the inflammatory cycle and is usually best suited for small breed dogs (less than 15 lbs) with mild disease. Large breed dogs with mild pain and incomplete (or partial) tears of the cruciate ligament may also be candidates for conservative therapy. Conservative therapies include weight loss, rest, anti-inflammatory drugs, and neutroceuticle therapy. Surgical treatment is intended to provide dogs with a functional limb with minimal discomfort.
There are several surgical techniques that work well for the treatment of cruciate disease but none have been shown to be superior to any other. The three main techniques currently in use include extra-capsular repair, tibial plateau leveling osteotomy (TPLO), and tibial tuberosity advancement (TTA). The choice of surgical technique should be made by you and your surgeon. Different surgeons have different experience levels with different techniques and different opinions as to which techniqueswill work best for your dog.Dr. Jehn explained that TPLO would be best for Stromboli. It involves changing the angle of the top of the shin bone (the tibial plateau) by cutting the bone, rotating it, and stabilizing it in a new position with a plate and screws. He explained the surgery step by step. The first part of the TPLO surgery would require removing the torn ends of the cruciate ligament and examining the medial and lateral meniscus cartilages. If a tear of either meniscus is found, the damaged part of the meniscus is removed.The tibial plateau leveling osteotomy - TPLO surgery involves making a curved incision in the top of the tibia bone (osteotomy) to include the tibial plateau. The tibial plateau is then rotated along the curved osteotomy in order to level the slope. A plate and screws are used to hold the tibial plateau in place so that the bone can heal well. Honestly, we didn’t understand any of this. I was thinking just fix him. Kevin was thinking make sure you save this dog for Jill and what is this going to cost. Both of us were thinking somewhere around $2000.00. By the time he was done explaining the process. Kevin jumped to, “How much?” Dr. Jehn, said, With everything….cultures, x-rays, medications, nurse care, etc somewhere around $4000.00.
“I almost fell out of my chair. First of all I thinking nurse care? Cultures? I didn’t really understand what he was talking about or how indepth this was. Like I said, all I kept thinking was FIX HIM. Kevin asked when he could do it and he said they were moving into a new building so some time next week or if we were really gung ho, he could do it that day. Now the problem was, Stromboli is no small dog. It is not like we can just pick him up and throw him in the car. Not to mention, I don’t think I could have bared to watch him in that pain for another week. Dr. Jehn then left the room for a minute and let Kevin and I discuss things. We knew the cost was insane but what choice did we have. Stromboli was our child and because of our love for animals, the only choice was to fix his leg. Dr. Jehn came back into the room and Kevin told him, “Do it today.” I started asking a million questions about the recovery. We again had no idea what we were in for. Dr. Jehn said it would be a 3-6 month healing process. He did say that unlike healing from other some surgical techniques, a dog's recovery from TPLO surgery frequently is more rapid and complete. In his experience, about 50% of the dogs will start to walk on the limb within 24 hours after surgery. Within 5 days after surgery most dogs will begin weight-bearing on the operated limb. However, Stromboli is a Great Dane and has a considerable much more weight than other dogs. He told us he needed to lose about 25 lbs. He said he wasn’t overweight, but wanted him more lean. He also wanted us to know that 70% of dogs that have this happen on one leg have it happen on the other. I cried. He said x-rays will be taken at 6 to 8 weeks after TPLO surgery should reveal healing of the osteotomy site. At this time most dogs have mild or no lameness; when we evaluated our patients having TPLO, the average time for the lameness to resolve was 10 weeks.At 2 months after TPLO surgery, exercise in the form of leash walks should be gradually increased each week. Increasing the number of walks per day tends to be better than just increasing the duration of each period.At 4 months after TPLO surgery most restrictions of exercise can be lifted.
Full working activities can begin at 6 months after surgery. Unconstrained activity prior to this time can cause spraining of the soft tissues of the stifle (patellar ligament sprain) resulting in a prolonged recovery. With all the questions answered, they let us say goodbye to Stromboli. Of course, I was bawling. I hugged him and kissed him and let them take him away. About 4 hours later, they called us and Stromboli had came out of surgery. They had put the plate in and he was in recovery. We had told them to keep him overnight to watch him and make sure everything was ok. 2 days later, we went to pick Stromboli up. It was horrible. They helped us get him into our car, but we need 3 guys to help us get him out. We were so scared of hurting him. He had 25 staples in his knee all the way down. You needed 2 people to be with him at all times. He had to be walked with a hip holder and once was laying down, it was impossible to get him up, especially on our tile. He kept trying to get up and slipping. If he slipped, it would rip the incision and bleed every where. For 2 ½ nights, I completely stayed awake with him. Finally on the 3rd night, he would not sleep at all. He was pacing and panting and he would just sit up on his hind legs and look at me. I could not tell what was wrong with him. I looked under his leg and the staples had completely ripped open. Kevin and I called friends to try to help us get him up into the SUV because he was scare of the ramp.
First tip if ever going to get a Great Dane. Teach your Great Dane Puppy to use a ramp. You may think you will never need this, but in the event they get hurt a ramp will be a life saver. Stromboli is very protective but little noises and things scare him that he is not use to. When we laid out the ramp being 4 ¼ years old, he wanted nothing to do with it so it was impossible for Kevin and I to get a hurt Great Dane 4 feet off the ground into an SUV during an emergency when his leg was ripped open. Finally we got a hold of our brother in law who jumped in back with Stromboli to try to keep him calm. Kevin drove and I saw in the middle. The Animal Hospital Team came outside and helped get him out. They got Stromboli into the examination room. We finally told them, much to our dismay, we need to keep Stromboli here at the hospital until he is passed this “scary phase”. With our tile and these stitches, we are unable to take care of him. They understood and agreed. At the hospital, they have 24 hour nurse assisted care and could give him the care he needed. Later that day, Dr. Jehn called us and told us the plate had shifted in Stromboli’s knee and he had a temperature, this is what caused the staples to rip and his to get sick. Stromboli stayed at the hospital for 10 days. They had put something on the plate called a fixiture. Dr. Jehn called us every day. At the time of the calls we didn’t know what a fixiture was.
Then the day came when we picked him up. They informed us that we would be cleaned this steal rod type thing. They brought out Stromboli with a tube coming from his incision and ooze coming from where the fixiture was bolted to the plate. This looked very barbaric to Kevin and I. Again, our tile was much more slippery than the hospital and when the plate shifted, it caused Stromboli to have another $2000.00 surgery. We were very afraid that we was going to get hurt and ruin how far we had come. They assured us, he would be ok and we would just have to clean out the outside. We took Stromboli home. Where the area was bolted looked very infected, but he seemed to be using the leg better and had his appetite back. I walked him out front and kept him in a rugged room. I slept downstairs with him. We put all scatter rugs down stairs in the living room so that when the family was watching TV down stairs he could hang out with us and use the rugs to get himself up. Because he was laying continuously on the opposite side of the fixiture, he started to create a pressure soar on his opposite foot that was also getting infected. He has ballooned his foot way up and has licking it. They had wrapped that up and instructed us to keep it wrapped and changed it every few days. If he licked it, he could get infected. He also had to keep the saucer around his neck on all the time to he didn’t lick his would. This could cause infection. The saucer was always giving Stromboli anxiety attacks. It was honestly a constant battle. At the end of Day 4 of being home with the fixiture home, I notice more swelling.
We brought him back to Dr. Jehn. He told us he need to put a string of beads in. These beads were high powered antibiotics. They kept Stromboli there again. Once these were in, the problem was the incision could not heal up. The issue was if they took the beads out, nothing would fight the infection. If the infection stays in, the plate would have to come out and if the plate comes out the bone would not heal. If the bone didn’t heal…Stromboli could lose his leg. If they left the plate in, the infection could kill him. Kevin had to deal with this call. I was hysterical. I could only listen on the other end of the phone and every time Dr. Jehn would talk I would just cry uncontrollably. Finally over the course of a week, they decided to only take out 3 beads, leave the rest in and close the incision. Stromboli stayed in intensive care for another 6 weeks on and off.
He came home on January 31st. Another $4500.00 bill. When he came home on January 31st, the fixiture was finally off, but he still had the stitches and plate in. He looked really good though. He was hopping around and doing really well. We didn’t seem him on Christmas, but we knew he got the constant care at the hospital that we couldn’t give him at home. It also was not good for him to be putting him in and out of that truck with a leg not strong enough.He was very happy to see us. For the next four weeks, we kept him sleeping down stairs. He would bark when he had to go to the bathroom and we all hung out downstairs to keep him company. Something I should also mention is that, our normal vet took off in the middle of this to study for his boards. He left from November until February 1st, so at times we had to deal with vets that we were unfamiliar with. This is why when it got to point of talk of cutting off Stromboli’s leg, Dr. Jehn gave us his home number and said I am calling every day and looking at Stromboli’s slides from my lap top, so you can call me every day. It got very stressful when some unsure Doctor would call us sounding like they didn’t know what they were talking about. Today Dr. Jehn is back and deals with Stromboli first hand.
Around February I noticed a little oozing coming from the middle of Stromboli’s knee. We brought him in and Dr. Jehn saw him. He stated that he thought that plate was still in there and possible harboring some of the infection, so as we talked about since the bone was now healed it would be time to take out that plate. Time for another surgery. Dr. Jehn kept him that day. Took out the plate and kept him over night. Another $2200.00 bill. Also in between these bills, I am missing some bills here and bills there. It has been never ending. Once the plate was out, Dr. Jehn put Stromboli on a very strong antibiotic. 3 pills a day, every 8 hours for 2 weeks. It has some side effects, but he did very well and finished the 2 weeks. His leg was doing very well, but a few days after his meds finished, I noticed some swelling and his leg began to shake. I took him back to Dr. Jehh. He said he looked very good, but may still have a bit of infection in there. So we put him back on the same antibiotic. On Thursday of this week, Stromboli had a decreased appetite and a case of diarrhea all over the house. Dr. Jehn decreased the meds to two pills twice a day. There has been no diarrhea but still decreased appetitle. This is common with this medication, but we are hoping it’s enough to just get rid of this last bit of infection and we are done with this.
If I can give any advice when it comes to your Great Danes, I would say controlled walks every day. Great Danes are very rambunctious and love to just throw themselves around but don’t realize that they have a lot of weight on tiny legs. I would also teach them to use a ramp if you have an SUV or a truck. I would also tell you to keep them lean with that nice arch in their hips. Stromboli was at 170 and was by no means fat but as lost 25lbs. It has made a huge difference on his recovery. He was able to lift himself him and gain muscle back in that leg. Stromboli has a dog bed in every room. Concrete floors are not good for them. Look online and you can get some really nice beds that were created just for Great Danes. He is so use to them now, he won’t even lay on the carpet. Stromboli use to lay on our bed, but I am so paranoid about his hurting his legs jumping off, I don’t let him. Keep them low. Also remember, cruciate disease can happen in any dog. It is common in labs and rotties. It even can happen in small dogs from jumping off furniture.
This has been the worst experience ever. This dog has had a horrible experience. Most people can’t afford the care that Stromboli received. I thank the lord every day that we were able to care for him the way we were. He is part of our family and we love him more than anything. I wouldn’t wish this on anyone. Cruciate disease is something I had never heard of. Because of a Great Danes build every one should be aware of it and maintain that leanness of your pup. It could make all the difference. I felt so guilty for a while, but Dr. Jehn assured me that Stromboli was one of the best looking dogs he had ever seen and there was nothing I could have done differently. He said to thank both myself and the breeder for that.
If anyone has any questions, I would be happy to answer anything I can. Just ask Tanya for my contact information. Stromboli is still a happy, loving SPOILED dog and is doing well.