J Bar’s Magnificent Beauty “Bella”

_BellaCropBella has quite a long story behind her.  She, I beleive, is one of the most beautiful dogs I have produced to date.  Her beauty and personality take my breath away.  I had very high hopes for Bella until she broke her left leg and the vet pinned it with a crooked pin and it healed so crooked there was no way to disquise it so that she could show.

She is an overall “family dog”, and is a “love the one your with” kind of gal.  She doesn’t care who it is, so long as she’s the center of attention.  My youngest son Jeremie has claimed her as his own, and she “goes along with it” most of the time.

Bella was born in 2011.  She took my breath away when she was born, and I just knew that she would be the “one”.  The one to bring my kennel name to recognition by so many people who’d never heard of me, or those who wouldn’t consider helping me enter the world of showing dogs, and especially to those who were down right mean and hateful about it.  She will be the one to help me elbow my way in and be regarded as a worthy competitor.  Only, she wasn’t.

She was my beautiful, perfect girl that was going to map my way to significance in this hobby that I was so determined to find success in.  I love everything about showing and breeding dogs, and all my hard work and determinations had paid off, in HER.  But only, it didn’t.

I have found success in the show ring, and have made many wonderful friends, more than I ever dreamed I would.  But it wasn’t with Bella, because before she was even a year old in 2012, she broke her right arm when she jumped out of my son’s arms while he was setting her down and she landed wrong.  She was an extremely hyper girl and hard to hold on to when she decides she wants down.  She could not have been more than 5 or 6 inches from the floor when this happened.  It was pinned, but there was a substitute vet that day, and I guess the pin bent as he was trying to get it inserted.  Being a substitute vet, maybe he didn’t realize that she was intended to be a show dog, and straight healing was imperative.   And I don’t think he ever even realized the pin was bent.  It was a few weeks/x-rays later, and the leg already healed, that I could see the pin was clearly bent in the x-rays.  Therefore, her leg healed crooked, so that her center of gravity is inside where her paw rests when standing on it.  In the way that it is bent, she bears the brunt of her weight on the inside toes of that paw.  Her chances of being a show dog were over, but she was, is, the most beautiful and otherwise correct dog I have ever bred.

And things get worse from there.  Her crooked leg hadn’t been healed six months when she was running di-dos around the yard and flew onto, then off of, the yard bench.  I knew when she hit the ground, that she broke a leg.  Running to her, I repeated to myself “please be the same leg, please be the same leg”.  I knew two bad legs would make life harder for her eventually.  It was not the same leg.

I rushed to the vet and it was pinned, but in a way I’d never seen before, by a newly graduated vet.  I kept thinking to myself, “he’s new out of school; everything he learned is fresh on his mind.  This will work”.  I willed myself to have confidence, even though I couldn’t visually see how it could possibly work. I’ll include a picture of it in the gallery.

Three months later, it was still broke.  No signs of healing, so we were referred to an orthopedic surgeon out of town.  Far enough out of town, that it was a two day trip.  The ortho vet plated the leg and did a bone graft to aid in healing.

When I followed up a month later with my local vet, and got an x-ray to see if any healing was apparent, there were still no signs of healing in the radius, but the ulna had healed.  I asked if he could see the bone crumbles (the graft) that had been placed in the gap of the break, because I couldn’t see them.  He said they’ve disappeared, and that it’s pretty common that the crumbles don’t work.  By now, we were supposed to remove the wrap and let her start using the leg.  She refused to use it and with no signs of healing, we opted to leave it wrapped another month.  That is probably the biggest mistake in the whole ordeal.  I didn’t realize she had to start using it, to stimulate blood flow and healing in the area.

After another month, we decided to let her learned to use the leg.  It was plated, so it should hold together, even if the bone doesn’t heal.  She continued to refuse to use the leg.  Six months out, my local vet told me to just let her be, she’ll eventually learn to use it again.  So, I learned to ignore that she would carry her leg and rarely set it down.

As time went on, she did start using the leg to balance herself when she was scratching an ear or cleaning herself.  She’d set it down about every third step when walking or running and even appear to drive with it a bit, when she’d take off after a bird or something.

Around Thanksgiving of 2014, I noticed that when she would sit up and bare any weight on it, the leg would bend.  I thought surely that’s an illusion.  How could it be?  It’s plated, and plates don’t bend.  So I started watching it closer.  By Christmas, I was confident it was not my imagination, it was really bending!  And on top of that, when she would set up and use that leg to support herself a little, she would sometimes have her knuckles buckled under, as if we are to make a fist, and rest on our knuckles, with fingers underneath the palm of our hand.  I knew for sure it’s not supposed to do that….that looks like nerve damage!  So, to the vet we went.  The x-rays showed the plate had broken. I’ll also include those pictures in the gallery.

So my vet removed the plate and inserted a pin.  Since the bone was obviously not going to grow back together, the intentions was to insert an internal pin, that would stay inside the bone and would bare weight, should her other, crooked leg ever give out.  It was a genius idea.  It won’t matter if the bones grow back together, the pin will bare weight if ever there was a need to.  She obviously wasn’t going to use the leg anyways, but in a pinch, she’d have the ability.

That was awesome….in theory.  But, during the surgery, it was discovered that there was “soft callous” connecting the two bones.  That is the first part of the bone healing process.  The soft callous forms from the blood clots around the fracture site.  Next step is hard-callous, that allows resumed but limited use of the limb while the calcium, phosphorous and collagen form new bone tissue to repair the break and remodel it “good as new”.   The hard callous acts as a substitute for the bone, so that it can be put to limited use while the bone cells remodel over the course of a couple of years.

The vet did not want to disturb the callous, so he drilled the pin in through the wrist.  There was tremendous swelling and trauma from getting the plate off.  It was embedded into the bone.  After about a week of daily contrast hydrotherapy (hot as we could stand it for 30 seconds, cold as we could stand it 3 seconds, three time, ending on cold)  the swelling was down and the leg was looking really good.   I would have preferred to use a shorter pin, but this will do.

Then the pin began to migrate out of the bone, and through the skin.   Rushed to the vet, he was out sick.  The on-duty vet pushed the pin back in and would call the doctor and decide what we are going to do about this new problem.  I was worried about infection if the thing keeps coming out, and it’s not a natural feeling, to push a metal pin up into a dog’s leg.  I was freaked out just a little bit.  Doc ended up being out a couple days with a bad stomach bug, so another on-duty vet wrapped her leg and sent her home….the wrap should keep the pin from coming out.  But it didn’t.  I continued the hydrotherapy, increasing to twice a day since her leg now has to stay wrapped and there would be no other stimulation for blood flow to the area.

About a month, post-surgery, the pin quit coming out.  “Ok” I thought.  “The hole in the wrist must have closed so that the pin has quit coming out”.  Took her for an x-ray to monitor healing, still no signs of healing, but the damned migrating pin was not where it was supposed to be.  One of the times I pushed it back in, (or maybe even when the other vet pushed it back in) it missed the upper bone and now rests inside the lower bone, and alongside the exterior of the upper bone.  Doc thinks it’s not such a bad thing, it will act as a splint and thought we should just leave it there.  So I opted to leave it, but continued hydrotherapy and wrapping.  A few days later, I noticed the danged thing moves around in there.  Alot.  So, not liking that idea, or the damage a moving chunk of metal can caused, I looked for other options.

There’s bone cement, but that’s usually used to fill in holes that are left by screws and it appears to create adverse reactions in some dogs.  That didn’t sound like a viable option.  But there’s also “Bone Morphogenic Proteins”, used to fuse vertebrae together in humans during back surgery for degenerative disk disease.  I can find studies on it, where it has been used in dogs to fuse fractured bones together, but no reference to vets who use it.  It would be very difficult to find it and another ortho vet confirmed when I asked, and it can’t be found commercially.

Then, there’s Stem Cell Therapy.  Stem cells are collected from umbilical blood of puppies, mixed with a solution of saline and serum, and inserted into the fracture.  Studies show significant bone growth and healing in just two weeks with no adverse reactions that I could find online.  Good as new, in some cases, in less than four weeks.  Some of those cases had bones that were in much worse condition than Bella’s bone.  Bella’s bone is still very clear in x-rays, where some of those bones in the study had significant decay, where they were quit transparent in the x-rays.  If anything will work with Bella’s leg, I think it is this Stem Cell Therapy/treatment and there is a vet only 3 hours from us that performs the procedure.  But, this vet says that unless I kept her umbilical cord blood from when she was born, those stem cells are controversial and therefore are also not available commercially.

Lastly, a bone marrow sample can be taken and sent to a lab in Denver, where stems cells can be extracted and cultivated.  Takes about two weeks to get them back.  This is the best option available to us.  It will be mixed with serum and plasma and injected into the fracture site when they replate the leg.  My son says her own stem cells will be better anyways, so there’s less chance of her body rejecting them.

This procedure was done on April 2nd 2014 (the date of this post).  Discharge instructions are to keep her confined for two weeks, only allowed to potty on lead, no free movements for her.  Cage rest, and potty at the end of a leash only.  After a week, replace the wrap and bring her back for a check up after two weeks, where the wrap will be removed and she will be permitted to walk regularly, but no running, jumping, climbing stairs or anything strenuous for two months.  Just calm walks.  My fingers are crossed and I’m holding my breath that this works.  It is our last option.

The Stem Cell implant worked, but Bella had to be off her leg for so long, that the rest of her bone had atrophied so bad that it broke right away.  It took a month to research what to do next and how to do it.  The next step would be rhBMP implant (recombinant bone morphogenic proteins).  It is a synthetic material, modeled after bovine BMPs, which is a protein that stimulates bone growth.  It sort of sends out a signal, a “call to action”, sort of,  to the stem cells within the bone marrow.  It calls the stem cells out to built bone cells.  We had to get special approval from the FDA, for “companssionate use in a dog”, and once the FDA approved the procedure, we had the BMP kit within a week and they were implanted, and due to half her radious having disappeared in atrophy, we had to do an external fixator, instead of the plate and screws.  The external hardware will at least be easier to remove.

At our 2 week check up, there was no notable bone growth, except that the screw holes had filled in.  At our 5 week check up, which was only 3 weeks later, I was stunned!!  My jaw litterally dropped because her radious had grown back!  You can see in the picture of the compared exrays….half the bone is gone in one exray, not even there anymore, and in the new xray, the bone had nearly completely regrown!  We plan to remove her hard ware on Friday Sept 18th, as the doctore expects a complete regrown and bridge to be completed in just 3 more weeks!

It has been over a year since my last update.  Bella’s leg did grow back, but when the tendons started to regrow and attach to the bone, it caused the bone to grown in a twisted manor and the final result is that the leg is not usable except when keeping her balance.  She gets along well on 3 legs, but the back legs are beginning to show signs of stress due to being the main sources of weigh bearing.