An ACL tear and TPLO journal

[Sue R]

The hock, showing virtually no remaining swelling -

 

 

Another shot of the hock which, compared to the photo I took several days ago, is a huge contrast to the swelling that made him look like he had a capped hock. It looks a bit puffy in this photo inside the lower leg but it is not at all -

 

 

He's bright, alert, raring to go - I have to be very careful to leash him when I take him out of the x-pen because he has no concept of moving "slowly". He's getting more comfy standing on this leg to pee but still has to hold it a bit forward when he poops (did I mention two good ones again yesterday?). Shari explained that he's not got the flexion yet in that leg and it will be a while. Exercises that we will start in about another 10 days will help restore both his extension and flexion in this leg (we are continuing those for the other three legs, and did that all along prior to surgery as well).

 

I could not be more pleased with his progress!

[amc]

It's wonderful to hear how well Celt is doing this time around! Your excellent care is paying off, Sue! That leg looks amazing!

 

Amy

[Gideon's girl]

On the incision side I could definitely see where the drape clamps were placed. His recovery is looking amazing!!

[WildFlower]

Wow, what a difference. He looks great!

[urge to herd]

Wow indeed - way to go, Celt and Sue!

 

Ruth and Agent Gibbs

[Sue R]

And a short video of Celt last evening, five days after surgery (certainly a time I wish I had editing software to get those beluga legs out of the video) -



I hope this link works for you as it's not working for me right now.

[chene]

It's telling me the album is private.

[Sue R]

http://smg.photobucket.com/user/edsuerayburn/media/Celt%20ACL%20tear%20and%20TPLO%20surgery/DSCN3982_zps659700ab.mp4.html

[Sue R]

Sorry, don't know if that will work. I didn't have problems posting from Photobucket after the last surgery but I am having issues now and I don't know how to do it otherwise. I'll have to figure it out.

[chene]

Hmm, yeah, it's not loading for me. Maybe just put it up on youtube or vimeo or something?

[Maralynn]

Hey Sue - just wanted to let you know that a friend from another corner of the internet just found out her dog tore a ligament and needs TPLO surgery. I sent her to this thread since it has so much excellent information. All the the time you're taking to update is very much appreciated!

[Sue R]

Sorry, not being successful at all. I'm trying to upload to YouTube and see if that works. I posted on FB and someone else can view it but I can't - I just get sound and no picture.

 

It is not easy being technically-challenged...

[Sue R]

Thanks for the compliment, Mara. I hope it's helpful to her. Of course, I hope she has a good surgeon and a good rehab/therapist to guide her.

Hey Sue - just wanted to let you know that a friend from another corner of the internet just found out her dog tore a ligament and needs TPLO surgery. I sent her to this thread since it has so much excellent information. All the the time you're taking to update is very much appreciated!

[Sue R]

^{Maybe this YouTube link will work -}

 

 

^{It worked for me while the Photobucket and FB attempts did not. Will also post to FB.}

[chene]

That one worked! It's amazing how well he's using that leg so soon after surgery. Good boy Celt!

[Sue R]

Thanks! He walks very well, When he gets up from lying down, he holds it up a bit but that doesn't worry me. He walks well on it but if he tries to speed up at all, he tends to skip. He's always on leash except in the x-pen and in the bedroom at night so he has little chance to speed up. He can go up and down the two steps he has to navigate to go out and we have gone from me lifting or supporting his hind end with the sling to him going reasonably slowly himself, using one foot for each step up or down.

 

I have to totally remind myself to *not overdo* things or let him progress too quickly because it would be too easy to stress/strain/hurt himself.

 

I credit it all with him being in better condition and fit weight for this surgery.

[Sue R]

It's easy to get cocky and think you've got it all worked out and then you find out you are wrong - our son, who was visiting overnight, took Dan outside to play. I heard a strange noise in the family room and came in to find Celt standing with his forefeet up on his crate (so he was standing on just his hind feet), trying to watch Jim and Dan playing out in the yard. Not the best thing for his leg! However, I think no damage was done and I learned a lesson - put the dog in the crate if we are taking the other dogs out for a walk or other fun time that Celt might get excited about.

 

I thought I had all bases covered...but Celt threw me a curve ball!

[Sue R]

4 Jul 2014 - seven days post-surgery

 

I realized today that Celt is not sitting yet, at least not much. He's got the one leg up or not bearing much weight when he stands; he walks very well; he will hop or skip if he tries to trot or move more quickly than a gentle walk; and he lies down carefully but can lie on either side apparently very comfortably. But he doesn't sit, at least not symmetrically. I think that leg is still just to stiff to allow a regular sit.

 

I'll be watching to see how he progresses with this. Meanwhile, he spent a lovely hour out tied up and lying in the cool grass while Jim and I picked berries this morning and since the other dogs were inside (they were not staying put with us like they should), he was an "only" dog and loving it!

 

Now I've got to get outside and mow grass. Ed is mowing hay. The sun is shining. Life is good.

[Sue R]

11 July 2014 - two weeks post-surgery

 

I took Celt up to PVSEC for his two-week post-surgery exam, where he was seen by Dr Anderson, the vet who oversaw the resident who performed the surgery. I really liked this vet who, coincidentally used to have a Border Collie and is fond and respectful of the working dogs.

 

He was very pleased with Celt's progress. You can hardly see the incision and I really think the healing went so much more quickly using surgical glue on the skin instead of staples, which were used in his first surgery. The vet, Dr Chisnell, who did the surgery, did an outstanding job of the surgery and of putting him "back together" after. This just healed up so much more quickly than the first incision did.

 

He found no discoloration, swelling, heat, tenderness over the surgical site and plating. Celt's ability to walk and put weight on the leg as well as he does at this stage pleased the vet, as did the mobility of the joint (and of all the joints in his leg). He said that although the printed protocol for recovery is "very conservative" that since we'd done this before, since Celt is under Shari's care for rehab therapy, and since he is doing so well, that I can disregard the protocol timeline and proceed as Shari and I see fit, based on how Celt progresses. And we go back in six weeks for the final x-rays and check-up. A six-month check-up is also on the books but only if needed.

 

And, after getting to Pittsburgh a bit early and getting seen within minutes, we were on our way by the time our appointment was scheduled. Since our timing would allow it, we were heading to Shari's for a rehab session so we didn't have to go out on Saturday. Well, that was the plan until I found that the highway on-ramp was closed. So we went down the road a ways and turned around to get on from the other direction. Nothing doing, that was closed, too. So back to PVSEC to get on I-279 which I thought would take me to I-79. It didn't (you have to get on I-376 which is labeled for the airport and not "to I-79"). We wound up in downtown Pittsburgh (which was really lovely except that's not where I wanted or needed to be) and wasted an hour by the time we got out of the city on a four-lane, slow-poke, "road work ahead, be prepared to stop" alternate route. Thanks to Ed and to Shari, both of whom coached me on the phone, I managed to make it to Shari's with only a minimum of whining and frustration and tears. Well, maybe not a minimum...

 

Fortunately, Shari had a cancellation at 3 - while I wasted an extra hour getting out of Pittsburgh on down there, and waiting another hour for 3 pm to roll around, it was all okay in the end.

[Sue R]

Shari started off being pleased at how Celt was moving and did his laser and stretches. He got right on the pad for the laser because he has come to know that it makes him feel good. (Whoops, sorry, older photo from the last trip, not this trip.)

 

 

This was his first ROM on that leg since surgery so she was extra-gentle at the hamstring stretch -

 

 

And the stretch backwards -

 

[Sue R]

Then she added a flexion (and also an extension straight down, which he really likes because I massage his muscles when I do that) -

 

 

And starting back with an exercise we've done before, after the other surgery, but not previously since this surgery, the three-legged dog. When she lifts the "good" leg off the ground, she is careful to support his weight with her other hand under his abdomen so he can't slip or fall. She only lifts it about two inches, just enough that he has to bear weight on the surgical leg but that his balance stays centered -

 

 

Then when she lifts the surgical leg, she takes it as far up as it comfortably goes since his other leg can take the weight and balance change (her hand under his belly still minimizes this), and this is an addition exercise to restore flexion in that leg after surgery -

 

[Sue R]

For some reason, my attempts to video his underwater treadmill seem to have failed. She used a fairly high water level, just to the bottom of his chest, and he did three sessions of 1 1/2 minutes each. She'd hoped for two minutes but felt he tired a bit too quickly for that and opted for safe rather than sorry. This was much better than what he could do after his first surgery where she had to use water about mid-way up his sides the first time, and could not walk him at all this long.

 

Since he was worked relatively hard and pretty tired, she suggested a pain pill at suppertime. By this morning (the day after) he seemed to be doing just fine and I did not give him another with his breakfast.

 

My job this week, until his next appointment (we are aiming for weekly appointments) is -

 

Control activity - he's loose in the house much of the time but not if I can't watch and monitor him. At those times or if he gets too excited, he's back in the x-pen.

 

Continue light walks. As he has walked (gently) as much as the equivalent of a 10-minute walk once a day for the last couple of days, I can increase at least one walk a day to 15 minutes, as he shows me he can do it. One or two other walks of 10 minutes or so are fine, and 15 minutes when if he seems ready for it.

 

Twice a day ROM exercises, about six repetitions for each.

 

Twice a day three-legged dog exercises, about six repetitions each.

 

What I can feel when I do his exercises at home is that he resists a bit on the ROM but has good range. It's real easy to lift his surgical leg on the three-legged dog and he's pretty solid on the good leg, but he is reluctant to have me lift his good leg and make him bear the weight and balance on the surgical leg. So I am really gentle and easy with him.

 

He walks really well. Without his hair being shaved, you would not notice any limp or shortness of gait. His toe-ing in and keeping of his good leg foot on the ground until the last possible instant when walking (to bear more weight and spare the bad leg) is getting less noticeable as his walking gait returns quite close to normal.

 

He can (and has been able to since the day or two after surgery) stand on either hind leg to urinate without any problems. He can't speed up with taking a hop or favoring his surgical leg yet, and so we try to minimize any effort at a fast walk, trot, or canter. We can't always avoid it unless I wanted to have him confined or leashed constantly but we do our best to manage him to minimize it.

 

All in all, we are well pleased.

[Sue R]

Some things I have noted -

 

Just because a vet has a lot of experience doesn't mean that that vet is necessarily the best option or will use the best procedure. Sometimes vets with a long history of experience may get stuck in a rut, I think. They do something, it works well, and that's how they do it even when there are advances made in procedures.

 

Just because a vet has less experience doesn't mean that that vet is not a good option or won't use the best procedure. That "newer" vet may be trained in the latest and most advanced procedures, which may be better than older (although still very functional) procedures.

 

On the other hand, sometimes newer procedures have not yet stood the test of time. When I consulted for Celt's first surgery, I also asked about a TTA as an alternative, less-expensive option. Dr Payne, his surgeon for that leg, has done TPLOs for over 20 years, and did do TTAs for a few years, but felt he did not like the results as well and chose not to use that form of surgery any more. So, a case of (in this vet's opinion) newer doesn't always mean better.

 

I think board certification is a must-have and, In Celt's case, the vet who actually did the procedure was a resident (on her last day of a three-year residency) but under the supervision and direction of a board-certified vet with seven years' experience. I was very impressed and also liked a couple of things they did on this surgery that were different from the first surgery - the incision was shorter and the incision was closed with surgical glue, not staples. Procedurally, it was done a bit differently, without a stabilizing rod inserted for the procedure that was removed at the end. Newer ideas? Maybe. Better ideas? I liked them while Shari prefers staples because they do allow for drainage that glue does not. However, since Celt did not have any drainage after the first surgery, would it matter?

 

There's often more than one way to do something well and going through something like this is certainly a learning experience. What I'd take out of this is to go to the best specialist you can for something pretty serious and complicated. Don't ever be afraid to get a second opinion (my consults with the ortho vets each of three times I've been there have only been about $100 or so, with me bringing my own x-rays for the consult from my GP vet). Don't be afraid to ask other people about their experiences with similar work. Don't be afraid to say, "I can't afford this. What are my other options?"

[Sue R]

15 July 2014 - 2 1/2 weeks post-surgery

 

Not much to report except that Celt seems to be doing well. I have to look carefully to even find the incision - I do like how nicely that has healed after the use of the surgical glue versus the staples that were used on the first leg. I think it was less trauma to the tissue, too, and more comfortable for Celt.

 

He's walking twice a day, 15 minutes each time, and I think he'd be up for a longer walk but we don't want to overtire him - the point is to carefully build strength not push the limits. He's sometimes a bit resistant on the ROM exercises. HIs surgical leg is getting much more flexible and developing more range in both the hamstring stretch and the backwards extension. His good leg can be a bit stiff, which is to be expected since he uses that to bear more weight. His gait is becoming more symmetrical at the walk but he still gives a bit of a hop if he breaks into a faster gait, and I bring him back to a walk as soon as I can. In the house, where he is loose, he can trot or run for small distances but I do try to control and limit that. Without having him on leash all the time or keeping him in the x-pen, I can't prevent all of that.

 

Here are his post-surgical x-rays, first the anterior view -

 

 

And the lateral view -

 

[Sue R]

(Sorry, pictures, etc., will follow but I've had computer issues. Here's a quick update.)

 

17 Jul 2014 - almost three weeks post-surgery

 

Our visit to Shari went well. Laser treatment and stretching (ROM) exercises were followed by the underwater treadmill, where Celt did three sessions of two minutes each. He did really well, only showing signs of tiring at about 1 minute 50 seconds for each go. Shari had the water level almost to the bottom of his chest. Again, I marvel at just how much better he has done this time versus last, with him being in much better condition going into surgery.

 

His thighs measured 38 1/2 cm on the old surgical leg and 36 cm on the newly-repaired leg. Of course, the second leg has no hair and so part of the difference is hair. Taking that into consideration, there is probably not much difference between the muscling on the two legs, maybe 1 - 1 1/2 cm. That's a good sign.

 

I have been having issues with his three-legged dog exercise because he knows how to lean his weight onto the good leg when I am holding it up so that he isn't really putting much weight at all on the left leg. I talked to Shari about that and she made a couple of adjustments to how I was doing it.

 

First, as shown in the photos above, I need to make sure that I only lift that good, right leg up off the floor a tiny bit and also bring it back rather than straight up. Both of these reduce his ability to put his weight into my hand. Also, the hand under his abdomen is used to shift his weight leftwards onto the weak leg, to make him rest the weight there. It's a little like patting your head and rubbing your tummy at first, to coordinate what you are doing with both hands, but I got the gist of it fairly well.

 

Our routine for the upcoming week is to increase his walks from about 15 minutes to 17-18 minutes as Shari wasn't convinced he was quite ready to move to 20 minutes yet, still on leash and keeping him to a walk as much as possible (he'll sometimes trot a few steps to catch up after sniffing). Also to do his ROM exercises, six reps of each, on all legs. And to do the three-legged dog, six reps on each side.

 

We are both real pleased with his progress. He is full of energy and optimism, and it's avoiding overdoing that's the issue!