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An ACL tear and TPLO journal


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#1 Sue R

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Posted 18 June 2012 - 08:03 PM

With Eileen's kind permission, I am going to keep a journal here about our experiences with Celt's ACL injury (I've seen it called Anterior Cruciate Ligament and Cranial Cruciate Ligament but, since most people refer to it as ACL, that's what I will do here).

It's already a bit long-winded, and it's barely started yet, but if our experiences can help just one other owner and their dog, it's worth it. Plus, it lets me ponder about and review our experience, and see the progress made over the time from when he was first hurt until he is (hopefully) fully recovered.

Photos will accompany the text starting post-op.

I am not a vet, not a trained technician, or anything of that sort and claim no medical knowledge. What I write will be what I understand from my observations; from what the veterinarians and therapist tell me; what I read in my internet research. Please, if you have any questions about your own dog's soundness or health, consult your vet!

Those who have experienced a similar injury and/or surgery are welcome to add their remarks!
Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#2 Sue R

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Posted 18 June 2012 - 08:05 PM

May 2009 until Winter 2012

It was three years ago this May when Celt, just in the prime of his life at six years of age and physically fit, came out of his crate one afternoon on just three legs. I have absolutely no idea what caused it. In fact, we were in Kentucky where I was volunteering at the Bluegrass, and Celt was doing nothing more than hanging out with me, lounging in or by his crate on a tether, or playing with other dogs or an occasional game of fetch with the Chuck-It.

There was nothing I could see that caused an injury Ė no stumble, no catching his leg in a hole, no big leaps or jumps. He just walked out of the crate in mid-afternoon with one leg held high.

Over the next few days, and when we got home, there was a pattern. Heíd come out of the crate, or rise from resting for a while, with that one hind leg up. Within the space of a dozen steps or so, heíd have his foot down and I could see nothing wrong. Now I get a bit stiff if I sit or if Iíve been sleeping, and I walk out of that pretty quickly so I thought this to be something like that.

But, to make sure he was okay, I took him to the vet when we got home. She examined him and diagnosed a soft tissue injury, put him on Rimadyl and restricted activity for a few days, and told me to bring him back if it did not resolve. And it did not, although I probably didnít restrict his activity as much as I should have, and Iíll admit that.

Back to the vet office a few weeks later, to see another vet Ė who diagnosed an ACL tear upon exam, and even had me bring Celt back, fasting, for a drawer test (checking to see if the joint moves *like it should not move* under sedation, where the dog is not masking the movement by activity resisting the manipulation). The vet said that drawer test was positive in showing damage to the ACL and that Celt needed surgery.

X-rays taken at the time showed no obvious problems (soft tissues do not show up clearly like bone does) and no signs of arthritic changes. The lateral view shows the joint in question, with nothing obviously wrong.

Posted Image

The dorsal view shows a little imbalance between his left and right knee joints that the local vet felt might be indicative of an ACL issue. And his hips looked very nice!

Posted Image

I chose to get a second opinion and, with my vetís referral, we went to PVSEC, a specialty and emergency facility near Pittsburgh, to see a board-certified orthopedic surgeon. She did not see anything in the x-rays that she felt was indicative of a problem, nor anything to cause her concern on her manual exam. So, while we had an appointment for surgery later that day, to my surprise, Dr Robb (now Dr Compton) diagnosed it as a strain of the ACL, and prescribed three weeks of crate rest with the first two weeks to also involve Rimadyl and no surgery needed.

That seemed to do the trick Ė Celt ended that period of treatment walking, running, jumping soundly (of course, I eased him back into activity but, again, probably not as slowly as I should have).
Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#3 Sue R

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Posted 18 June 2012 - 08:07 PM

Winter 2012 until June 2012

And for almost three years, he remained sound Ė no visible limping or favoring that leg, until this winter, when I wondered if my eyes were deceiving me or if I was seeing just a tiny little hitch when he came out of the crate. But then there would be nothing there and I thought it was my imagination.

But what I was seeing, and knew I was seeing it, was that he was holding that leg so that he was standing on tip-toe on just that foot Ė holding it slightly behind the other leg, and just slightly raising the foot so that the front of the toes were resting on the floor rather than the pad of the foot. My heart was hoping it was just a habit, just a stance, a kind of ready-to-move position but my head was telling me otherwise.

I was gone with Dan overnight to visit family and have a lesson on the way back. When I got home and let Celt and Megan out, I could see Celt definitely favoring his leg, and I knew it wasnít my imagination any more. Something was not right again, yet Ed knew that Celt had not done anything obvious to cause a limp while I was gone.

Back to the local vet who was just as sure this time that it was a torn ligament. One of the symptoms he asked about was if Celt was holding that foot on ďtip-toeĒ, which he was definitely doing. I didnít want to jump into surgery as an option since a conservative approach had worked before so we opted to try crate rest and Rimadyl again. In addition, family plans and a trip to Kentucky to work at the Bluegrass provided both an opportunity to try the crate rest but also meant that surgery could not be done immediately.

Celt had a dental scheduled for the week after the Bluegrass and, since he would be sedated, I made arrangements for his vet to also use that time to give his joint a good exam. I wasnít surprised when our vet said that he manipulated the joint very thoroughly and stood by his diagnosis that the ligament was definitely damaged. He felt that TTA, a surgery that he had been performing for several years, would be a good choice for an active dog of Celtís size. And I could have it done within about 10 days.

But I did not want surgery, or any particular choice of surgery, without seeing the orthopedic vet again, but this time I decided to have him seen by Dr Payne, as he was experienced with both TTA and TPLO, and I wanted a vet who would be familiar with both and could advise (and do) whichever he felt would most likely produce the best outcome/prognosis.

The only problem was that we had to wait almost a month to see Dr Payne, who is a board-certified orthopedic surgeon with over 20 years of experience and over 3500 TPLOs alone in his extensive resume. I decided that I could do the crate rest and Rimadyl, and we could take the time, to get Celt the best possible care that would be reasonable in our location. (PVSEC has five of only six American College of Veterinary Surgeons diplomates within a 100 mile radius of our home. If I wanted to stay at our sonís in Vienna, VA, there would be a lot more choices but it would also involve a longer drive each way for any visits.)
I felt extremely confident in our choice of surgeons. A friend in our area had the same surgery done on her GSD last summer, and her opinion has always meant a lot to me. She had it done by Dr Payne, and highly recommended him and his facility.

The next choice to be made would be a rehab therapist. The friend I just mentioned, and a close friend with a dog with a different issue, both recommended a rehab facility not too far away, with a certified canine rehabilitation therapist. While my vet office has a nice rehab facility, I neglected to ask (and they neglected to tell me) if the therapist was certified, and so I made the choice to take Celt to the therapist that I knew was certified and experienced. She is not only certified as a canine rehab therapist but has had a career as a human physical therapist, and so has a great deal of experience.
So, while I feel very confident about my choices of caregivers, this is still a very invasive and significant surgery that is, of course, not without risks. And the physical therapy is a vital part of the recovery that canít be overestimated.

I have also taken good advice to sign up for Orthodogs (a Yahoo group), as a forum where there is a lot of experience and advice available, although I will admit I was overwhelmed at first. Now, on daily digest, I am able to peruse the information there and not feel quite so swamped. And, as in similar fora, it often seems like *everyone* has major problems but, of course, thatís why people are participating and so problems are overly represented. And, since differing opinions are offered, and different dogs, owners, and surgeons are represented, it takes some sifting through the information to find that which is of most interest to me. I think it will be a valuable resource, and has given me quite a bit to ponder and prepare for already.

What I have found very difficult is the anticipation Ė the waiting as the time draws close for Celtís appointment. Hoping against hope that the surgeon will say that itís not a tear, itís something else. That it wonít need surgery but conservative treatment of some other sort. That Iím worried all out of proportion. And then, taking my naturally anxious nature, I am going to worry, big time. I may advise anyone else to trust their veterinarian, and that everything will be okay, and that Iím thinking of them Ė but, now that itís *my* dog and itís *his* serious injury and *his* serious surgery Ė well, the bravado and assurance are gone, pffft, and Iím just another worried, fretting dog owner whoís hoping and praying that all will be well in the long run, that the vet and staff will do the very best job possible, that I will be up to dealing with my part of the work, and that Celt will again have a quality of life and (most hopefully) be able to enjoy working stock again as my partner and being an active, happy companion.
Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#4 Sue R

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Posted 18 June 2012 - 08:09 PM

June 18 2012

Celt and I had our appointment today. Dr Payne met with us, along with his intern and another vet. All the staff were very professional, as you can imagine, at a facility like this. Itís not the same as our local vet office where we know each other by name; itís much more like going to a big hospital. But, I have to say that everyone was nice and polite, professional, kind and caring.

I had been hoping for a diagnosis of just a partial tear at most, since Celt could stand on that leg to urinate, could use it to give himself a tummy scratch, could walk (and be way more active than he should be) reasonably well with just a hitch in his stride, and was not ever holding the leg up in obvious pain.

But Dr Payne diagnosed a total tear with his physical exam, which was not what I wanted to hear but the surgery is designed to work for anything from partial (my friendís dogís was 20%) to total. He feels that TPLO is by far and away the best option for an active dog (for any dog, actually), doesn't think much of the TTA (and the claims made that it's less invasive, easier and quicker recovery, and so on), and didn't even discuss traditional (the fishing line or new-and-improved version that uses much stronger lines/bands).

He's done over 3500 TPLOs so has tons of experience, and he said his success rate is 96-97%. While I said that Celt being able to work again was not *the* most important thing (quality of life and lack of pain along with general soundness is), he said *his goal* with the surgeries he does is nothing less that restoring the dog to whatever full life it had beforehand - working, hunting, sports, companion, whatever. So, he has a very high standard of what "successful" is.

The good news was that while there are arthritic changes evident in Celt's x-ray, they appear so far to be minor. In addition, Dr Payne felt that while there was swelling in the joint, that it was minimal for the level of damage the ACL had sustained, and that was also a good sign. I guess we can credit the crate rest and Rimadyl for helping to minimize that.

Surgery is scheduled for tomorrow morning at 8. He said he was happy if I wanted another opinion but I told him *he* was the other opinion and, as far as I was concerned, the best option with his experience and his reputation.

I was a blubbering idiot and felt totally embarrassed. It is a long-standing family tradition that goes back at least to my maternal grandfather, the ability to produce copious tears about many things Ė happiness, sadness, anxiety, whatever. I told everyone (tech, vet, intern, etc.) at the very beginning that I would be emotional and I was, but that it was not a reflection on how I felt about my decision to have Dr Payne see Celt and suggest the course of action. I was and am very confident about that, I'm just a teary basket-case about something this serious - and just about leaving Celt there.

I think that was the hardest part because I was already convinced he needed the surgery (well, a tiny part of me still hoped it might be *something else* that would not need surgery but could be dealt with readily without surgery and a long rehab), that Dr Payne was the best choice (although there are several other vets at PVSEC who could do a great job), and that I have chosen the best person available (Shari) for rehab.

I have a list of limitations and expectations for the next eight weeks and I have to say that I was prepared to find things more restrictive than outlined. I'm going to set things up in the house for Celt, with a crate and x-pen "yard" in the living room, which will let me move the x-pen around as I want to so he can be in the family room with us or (once the skin is healed and staples out) even outside in the yard if I'm working out there, lying in the shade and having a change of scenery.

For nighttime, he just sleeps on his pad by Ed's side of the bed and we will try that. Once he goes to bed, he does not get up again and, if needed, I can always bring in Dan's bigger airline crate for a night crate (it's a 40"). Of course, Ed thinks I am being too anal as it is but I am not going risk recovery by being slack about things. If need be, I'll sleep in the living room the first few nights with him in the x-pen as our bedroom has a wood floor and is more slick than the carpet.

The hardest part was saying, "Good-bye" for today and watching him be led away into the back. He will be well taken care of but I do believe there will be some anxiety and stress on his part. I hope he realizes I would never leave him and not come back, and that I've only left him because that's what had to be done.
Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#5 urge to herd

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Posted 18 June 2012 - 09:00 PM

Sending good thoughts for Celt and you both. Something I've been meaning to mention - head rubs, (or brain massages, as a friend of mine says) seem to be very relaxing for my dogs. They just melt. Make sure you give Celt some good brain massages from me!

And get a massage yourself, or a mani/pedi, or some darn thing. If I could bring over home made cookies and a silly movie to watch, I would. I recommend Rat Race for the silly movie.

Ruth and Agent Gibbs, who turns into a puddle of blissful fur when he gets his morning head rub

#6 Sue R

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Posted 18 June 2012 - 09:22 PM

The dog's knee involves pretty much the same structures as the human knee but things are not necessarily in the same proportion or at the same angulation. There is a broad and strong ligament that runs from the femur (the upper bone) over and in front of the patella (kneecap, or that tiny little bone to the front of the lower femur), and down to the front of the tibia.

There is an anterior (or cranial) cruciate ligament, a strong ligament that runs between the opposing surfaces of the two bones. There is also the posterior or distal (or caudal cruciate ligament). The meniscus, a fluid-filled sac that acts as a cushion, is also located between the two bones. There are several other ligaments, located laterally (to the outside) and medially (to the inside) of the joint. All of these combine to stabilize the joint and yet allow it to flex and function in movement.

The primary purpose, as I understand it, of the ACL is to limit the ability of the femur to slide backwards along the tibial head. When it is torn to one degree or another, the femur slides backwards rather than just pivoting on the tibial head. This causes a couple of problems - the improper movement of the femur on the tibia results in arthritic changes (calcium buildup) on the tibial plateau (head), and can cause damage to the meniscus as it tends to then pinch off the edge of the meniscus. This can result in leakage of the fluid from the meniscus and reduces its ability to provide an even cushion for the joint.

Here is a diagram that I downloaded from www.dogforum.net.

Posted Image

Tears to the ACL can be caused by injury but there can also be a genetic component involved, and this is why in about 20% of cases, that the other knee joint experiences a tear, often because so much stress is put on that other, apparently healthy leg during the convalescence of the first leg.

While I am unaware if there is a genetic component associated with the ligament itself (and I don't see why there couldn't be), there can be one associated with the angle of the tibial plateau. The steeper the angle to the rear, the more stress is placed on the ACL to maintain the integrity of the joint.

One site explains it as visualizing a wagon (the femur) on a slope (the tibial plateau), held in place by a rope (the ACL). The steeper the slope, the more stress is placed on the rope (ACL). If the rope (ACL) is damaged by trauma and it is frayed at all (ACL partial tear), then it is more likely to fail (ACL complete tear).

If the reason for the ACL damage in the one leg is a steep slope, then it is most likely that the second leg also has a steep slope, and therefore is prone to a similar breakdown in the ACL when additional stress is placed on it due to damage, surgery, and recovery of the first leg.

I sincerely hope that Celt does not experience problems with his second leg which, so far, has shown no evidence of any ACL damage or arthritic changes.
Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#7 Sue R

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Posted 18 June 2012 - 09:27 PM

Thanks, Ruth! Celt is not big for head rubs (Ed is the king of doggie rubs here, and there isn't a dog immune to his touch) but he is a huge fan of fanny scratches - which are sort of off-limits right now because they get him dancing in the hind end. But I will take your advice and give it a try. Celt has always enjoyed having his chin and his chest rubbed, so perhaps that will suffice. And Ed does do a greatly-appreciated ear rub, so maybe he'll show me his technique. Somehow, I just never have the touch that he has...
Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#8 Tiga's_mom

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Posted 19 June 2012 - 07:27 AM

It may be a bit different for the TPLO and since you have a rehab therapist I'm sure they will direct you on this but Tiga loved getting his ROM exercises. I would take an ice pack and ice his leg first and then do his ROM exercises about 3 times/day at first. It would keep him pretty calm and I think it felt good for him. You have to be careful though to make sure you're doing it right but something tells me that protocol is different for TPLO then for a traditional. I'll be thinking about you both today.
~Tammy~

#9 WildFlower

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Posted 19 June 2012 - 07:55 AM

Sending good thoughts to you and Celt today, Sue.

Vicki

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Kitties: Merry Cat & Mr. Magoo

Chickens: Dixie, Fran, Mabel, and Hattie

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#10 2 Devils

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Posted 19 June 2012 - 09:06 AM

You do ROM exercises with TPLO as well. The one to be the most careful with is stretching the foot joint (the one connected to the leg - can't remember the name right now). This is very important because lack of use will cause it to lose some mobility in that joint. The stretch for it needs to be done correctly or you can cause damage to the surgical knee. You have to hold it a certain way which I can't explain in writing. My brain is tired :)

Truthfully, I found the 3-5 days were not too bad. It was once Foster felt better that it got harder. She was walking almost normal the day after surgery. It did get a seroma (?) from overuse but that was easily fixed by icing and trying even harder to keep her quiet. She also busted her stitches during the first surgery and had to be glued and stapled back together but there was no bleeding involved and she was still walking normal. Basically this was the only things that went wrong that you could see. Yes she slipped a couple times, yes she even jumped up and off the couch a couple times but it never caused an issue. We did limit her but she was a cattledog afterall and had her own thoughts at times.

I am telling you this so you know that you probably won't be perfect on keeping Celt quiet but that is ok. It will take a lot more than you think to mess up the knee after the surgery.


Foster went back to playing flyball 6 months after the right knee TPLO, 2 years later had TPLO on the left and was playing flyball again 6 months later. By this time she was 9 yrs old and her times in flyball were still pretty good (she only lost about .2 of a second).

Give Celt an extra cookie from us.
Kim
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Posted Image

#11 gcv-border

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Posted 19 June 2012 - 10:15 AM

Sue,
Thanks for taking the time to do this as I always like to be educated. I hope I will not have a dog with this injury, but with Border Collies, injury is always a concern.

Not wanting to sound stupid, I never asked what a CCL was. I knew about ACL injuries, but not CCL. So thanks for clearing up the ACL = CCL issue.

I wish I had done a log similar to this about 2 years ago when Torque tore his bicep tendon and had to have surgery. Time has blurred the specifics, and it would have been nice to go back and remember exactly what happened.

We traveled a similar path - very little outward signs, getting a correct diagnosis, surgery and rehab. He was back doing agility 6 months after the injury (4.5 months after surgery). According to the rehab vet (Dr. Canapp at VOSM), once rehabbed correctly, there is not much else he can do to harm that shoulder. Yes, but there is another shoulder! :D

Best of Luck to Celt and you. I will be reading.

Jovi

Jovi

"Folks will know how large your soul is by the way you treat a dog."  Charles F. Duran


#12 Sue R

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Posted 19 June 2012 - 04:25 PM

Not much to say today except - the surgery is over and the vet called to say that all went very well! He said he saw no reason why Celt should not regain full function but, of course, we have all of recovery and rehab to do before that happens.

One note on what Dr Payne found was about the ACL itself - in a tear that is recent, the torn fibers give the impression of a broom. Lots of fibers fluffing out and around the tear. Then, as time passes and scarification occurs, the feathery, fluffy appearance changes to more of what I'd call a stumpy, lumpy appearance.

He said that the tear had happened long enough ago that there was virtually no ACL remaining - just two little stumps at either end. The scarification was pretty much complete. I should have asked, and will try to ask, about how much time it takes for that to occur.

My feeling is that it happened, or at least the last of the tearing, since it may have been a gradual process, one time when I was not home - and when I came home with Dan (not sure if this was February, and I don't think it was, or a bit later when Dan and I were gone overnight), I said to Ed, "What happened to Celt? Why is he holding his leg up?" And, of course, that was the end of it and he put his foot down and seemed "normal" again.

These animals are very stoic and Celt was very fit. Both of these facts could have helped mask the problem if one other thing comes into play (and I want to ask the Dr Payne about this, also) - and that is the angle of the tibial plateau. A dog with a steep angle to that is more prone to a tear, as I explained above. But also if a tear is due to injury rather than just the "topography" of the joint, a steep angle will cause more instability. Celt's pre-surgery x-ray did not show what seem to me to be a very steep angle. So, who knows how long this may have been developing if the angle of the joint was not contributing to instability? Am I being confusing?

So I want to take the opportunity to talk to the vet about the x-rays because I think that tibial plateau angle could be a clue as to the likelihood of a similar tear happening on the other leg.

The vet was very cheery about how the surgery went and his outlook for Celt's recovery, which was very heartening. He also reminded me that I will get another call tonight, with an update on how he is doing. His call was after surgery and when Celt was beginning to come out of the anesthesia.

We have a handout outlining the general aspects of his activity for the next eight weeks, and I should be getting the specifics of what I should be doing (like ROM, massage, icing) for the next couple of weeks tomorrow. Plus, once I pick him up, I call the therapist to let her know when my appointment is for staple removal so that we can set up his first appointment with her for after that.

While the surgeon will not recommend therapy until about eight weeks post-surgery, she has had very good results with starting a program much sooner than that, carefully and gently. And Dr Payne was very impressed by the results of that program with my friend's GSD, who also had a TPLO.

One other thing, that I may not have mentioned, is that while Celt is about five pounds over his normal weight (almost two months of rest will do that, even with a greatly-reduced diet) and has been inactive for so long, that he had quite nice muscling and muscle tone. In fact, Dr Payne found it hard to believe that Celt had been under crate rest for so long looking at his physical condition and listening to his heart rate and respiration (maybe the dog has been holding out on me, and doing canine push-ups in his crate or something).

Meanwhile, I am rather giddy with relief now that the surgery is done and the doctor is pleased. The giddiness will probably pass as soon as I see the poor boy tomorrow!
Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#13 Sue R

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Posted 19 June 2012 - 04:29 PM

Even though I think it is correct in dogs to call it a Cranial Cruciate Ligament and a Caudal Cruciate Ligament (cranial for head and caudal for tail) versus Anterior and Posterior Cranial Ligaments, I think many vets and people still call them ACL and PCL because it's confusing to abbreviate CrCL and CaCL (or however that would be abbreviated).

I was trying to be correct in referring to it as CCL but since ACL seems to be the commonly-used name, I've gone back to using that.

Anyone here who is a vet or vet tech or who knows better, would be more than welcome to correct or clarify anything I say!
Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#14 Tiga's_mom

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Posted 19 June 2012 - 06:22 PM

Glad to hear he had a successful surgery! You guys will do great. Kim is right, there will be "oops" moments, but they happen to everyone. If you haven't already, you should read that file on orthodogs. Some of them are pretty funny and shows how strong the surgeries are. We had our share of them, especially since we had to rehab him in the winter and there was lots of ice everywhere.
~Tammy~

#15 Sue R

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Posted 20 June 2012 - 02:07 PM

Celt is now home, and just a brief summary so far -

He came through the surgery very well. He was drinking and eating well yesterday evening, peed and pooped last night (he probably won't poop for a few days more), and had a good morning, eating and drinking well. And was extremely eager to head for home.

I have instructions about his activity levels for the next eight weeks. We have an appointment to have his staples out in nine days from the surgery. Normally, that would be beween 10 and 14 days but, with 4th of July week, we had to move it back a day in order to see the same surgeon, which was my preference. If that had been determined to be too early, then we would have seen another but, since we could do it this way, that is what I chose.

Celt is set up in the living room with an x-pen attached to his large crate. He's got his padded bed in the crate, should he prefer to be in there, and a sheepskin/blanket combo in the x-pen. He has moved back and forth a few times, trying to figure out what is more comfortable - while he loves his crate and the secure feeling he has in it, I think he's realized that the "bed" I've made in the x-pen is really more comfy as it gives him more room and more options to stretch out.

He doesn't have the cone on right now as he appears to be leaving the incision alone. He had a little trouble in the car and I had to pull off and "re-arrange" him - while I had him in the backseat, as that is the best-cushioned and safest option, he is used to lying there with his head towards the passenger door. So, while I'd settled him in facing the other way, when he tried to move, he began to lay down on his repaired leg and that was not comfy, so I had to resettle him and then he stayed put for the ride home. In the x-pen, where he can have more freedom to lie down, he seems capable of lying of either side and getting up without a problem.

We are to do some range of motion exercises three times daily. They showed me and let me do them at the vet office. With him standing (or lying down (on his "good" side), I take his lower leg and push up towards the pelvis and down towards the floor, repeating this about 10 times. Then I take the lower leg and do the "bicycle" movement, moving the foot in a circle or oval like he was pedaling a bike, again about 10 times. This is to be followed by icing the surgical area (and warmth applied lower down on the leg if there is fluid build-up there).

A lot of dogs don't like icing, even with something as benign as a bag of peas. The therapist suggested a bag of soybeans or similar small dried beans. That way you get the cold and the ability for the bag to conform to the contours of the leg, but not the "shock" of an actual ice pack. I need to go and chill me some beans! The chilling should be done for about five minutes.

These exercises will help keep the leg from atrophying as much; reduce stiffening; reduce swelling; reduce adhesions in the surgical area; and help him to recover more quickly. They will also help me to have a good hands-on monitoring of the whole leg, noticing swelling, coloration, temperature, and an abnormalities.

I should not see any seepage, they said. That would likely be an indication of infection so, if I see any, I need to call them. He had antibiotics while at the hospital, and came home with Rimadyl (37.5 mg twice a day) and Tramadol (50 mg twice a day). The Rimadyl is anti-inflammatory and a pain reliever. The Tramadol is a pain reliever. He has one week's supply of each. The Tramadol is very bitter and it is important to administer that in a way to minimize the taste. Sliced cheese is our friend! Peanut butter was another suggestion.

Redness, swelling, or discharge about the incision is a reason to call the vet. A small amount of edema down near the hock is normal, as fluid from the post-surgical swelling will tend to migrate downwards for a few days.
Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#16 Sue R

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Posted 20 June 2012 - 02:19 PM

The post-surgery activity protocol is (summarized) here -

Weeks 1 & 2 - Crate, x-pen, or small room confinement when not supervised. Leash walks only for bathroom needs. Use the provided sling to help support the hind end when walking. It will help relieve some weight, reduce the chance of slipping or falling, and lend stability.

Weeks 3 & 4 - The same except that the ROM and massage/icing may be discontinued. (I actually think I'd like to continue this but we will start with the therapist at three weeks after surgery, and so at that point, it will be whatever she recommends.)

Weeks 5 through 8 - Begin walking short walks (like one to two blocks equivalent), always on leash. Only need the sling if the dog tends to want to jump or be too active, to help reduce that tendancy. If the dog shows any increased lameness, call the vet.

At eight weeks, there will be another visit with the surgeon with x-rays taken. If there is evidence of sufficient bone healing where the tibial head was cut, then rehab will start with longer walks and even slow jogging, always increasing gradually and avoiding all "explosive" activity (like ball games, jumping, frisbee). Stairs are now allowed, along with freedom in the house. Swimming is allowed. If there are any setbacks or concerns, call the office.

One more appointment should be scheduled for the end of 12 - 14 weeks. If all is well with the surgical site and there is sufficient muscle mass returning, regular activities will be allowed.

Of course, a lot of this schedule depends on how the dog is progressing (or not). And it will be impacted by the physical therapy. My friend, who went to this same therapist, was very pleased - and the surgeon was quite surprised and pleased with the progress her GSD made under the care of this same therapist.

So, that's the outline. I have to say I am very pleased with the service, care, and concern I have received at the surgeon's office. I have never felt rushed, whether on the phone or in the office. And I've always been encourage to call if I have *any* concerns.
Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#17 Sue R

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Posted 20 June 2012 - 02:46 PM

Photos and x-rays to come.

PS - Photos, yes. X-rays, maybe. The format for the x-rays that were emailed to me is a .dcm, which I don't have a program capable of opening. Likewise for the CD sent home with him, where I can view but can't seem to save the images. DH will attempt to help over the next day or so as he thinks he has a program at the office that may be able to open them, and then he can re-save in a format I can use. Maybe. If that's the worst of my problems, I'm just fine - frustrated, but just fine.
Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#18 WildFlower

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Posted 20 June 2012 - 03:09 PM

Glad to hear that Celt is home! :)

Vicki

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#19 Sue R

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Posted 20 June 2012 - 04:10 PM

In talking to the therapist today, making our appointment, I asked her a few questions. One was a question that I meant to ask the surgeon but in the rush of emotions and trying to take everything in, I forgot.

I asked her how long it would take a tear to go from the freshly-torn ("broom-like") stage to the contracted, stumpy stage that the ends of Celt's ACL were seen to be when the surgeon got into the joint. She thought it would take a lot longer than just the last two months that Celt has been on crate rest. I am interested to ask Dr Payne about that. This problem has likely been going on for a lot longer than I have realized.

One piece of good news that I might not have mentioned previously was that Dr Payne found no damage to the meniscus. Damage of one sort of another to the meniscus is very common in this sort of injury, so I could Celt as very fortunate that none has apparently occurred. Part of that might have been due to the integrity of his other tendons and ligaments (which all seemed quite sound) and his good physical condition (quite fit and not overweight), both of which would have contributed to maintaining a level of joint stability that would not otherwise have been seen.

Meanwhile, I went into the x-pen with him for a bit of a cuddle - he just wanted OUT of there but was quite happy to be stroked and petted and fussed over. He was not nearly so thrilled to have me do the ROM exercises, and definitely not in favor of the chilling by way of frozen lentils (which are much less "shocking" to the sore tissues than a conventional ice pack would be). But he was a good boy and stayed put when I told him to, and we've now done our first (of many) PT session!

The therapist was a bit surprised that Celt is willing to lie (on his own) on the side where the surgery was done. She was pleased saying that that was an indication that he could use that leg (even though he prefers to not use it in walking yet).

I can tell he's still stressed - he's the only dog out of three that is panting. But I can see that he is as comfortable as I can make him, with both soft and firm places to lie (bedding or carpet), plenty of room to maneuver into whatever position suits him, and in a familiar place that he considers his own.

Ed's on the way home and his plan is to get into that x-pen and do some snuggling. And Celt, *my* dog, will snuggle and cuddle with Ed which he does not like to do with me. Oh, well, anything to make the dog feel as good as he can. While he does that, I'll walk the other dogs so Celt doesn't feel left alone.
Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown

#20 Sue R

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Posted 20 June 2012 - 06:31 PM

Oops, forgot that Ed has an evening meeting so I fed the dogs and took Celt out for a pee. For some odd reason, he wanted to get back into the car in the yard. I guess that's because generally, when the car is parked next to the porch, it means I'm packing it for a trip. No matter how gimpy he feels, Celt does not want to be left behind!

Here are a few views of his leg, post-surgery. The first is from the outside and front. It doesn't look too bad from this angle. You can see he has lost a lot of muscling with his almost-two-month's of inactivity. And, with inactivity, the hair on his feet has gotten quite long, so we call him "Hobbit-Toes". Where he is clipped on this leg, they left the foot hair intact. Gives him a girly look, like those little white anklets girls wear with the lacy trim around the ankle. I try to tell him it's the look that all the stockdogs are going for this year. You can see it in this not-real-good view.

Posted Image

He *can* put his foot down but he doesn't *want* to.
Sue Rayburn - Cleverly disguised as a responsible adult, but not the brightest firefly in the jar.

Celt, Megan, and Dan

"When the chips are down, watch where you step."

"The happiest people don't necessarily have the best of everything. They just make the best of everything." - author unknown


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