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Sue R

Celt has reinjured his CCL

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I posted three years ago when Celt (age 6 1/2 at the time) appeared to have a CCL injury, and I won't go into that except to say that the local vet felt surgery was needed (exams, xrays, and drawer test) but the ortho vet felt it was not (exam and xrays) and so a conservative approach of crate rest and Rimadyl was followed, with excellent results. Excellent results that is until recently.

 

I'd been noticing Celt looking not-quite-right on that leg the latter part of this winter but either because it was such a "maybe not right" thing or just because I was putting it off hoping it was something else, I let it go on for a little while until the evidence that something was wrong was too much to ignore. He's now 9 1/2 years old and, minus the injury, still a good working dog.

 

I've had Celt to the local vet, who does most of the ortho work at the clinic where I go, for a couple of visits with crate rest and Rimadyl as the treatment in between visits. But I have to say that while I restricted his activity, it was certainly not enough and I know that. Sometimes, it's hard to balance family and life needs with a dog's special needs but that's no excuse.

 

Anyway, when Celt was in for his dental yesterday, and knocked out, the local vet did a more extensive exam of the knee joint and that only confirmed his opinion that the CCL, if not completely torn, is largely torn. Xrays show some arthritic changes that do not exist in the other, healthy knee. He does the TTA surgery and has been quite pleased with the results (but he has only been doing it for a few years and so has no real longer-term experience with it). He has also done the fishing line surgery for several years on smaller, less-active dogs, and would not (wisely) recommend that for a dog like Celt and of Celt's size.

 

I have a tentative surgery date with him for June 4th. My vet feels the recovery time for TTA is shorter than for TPLO, and that it is a simpler, less invasive surgery with less that can go wrong while still providing a good, stable result. He is quite enthused about the TTA as a surgical option.

 

I was able to get a referral for a consult with an ortho vet, but this time (while at the same practice) one who is board certified and also experienced in both TPLO and TTA surgeries. This practice probably does as many CCL surgeries in a day as my local vet does in a week or two, and this surgeon has many of both under his belt.

 

I was able to get a consult appointment for June 18th, the earliest possible, with a tentative surgery date for the next day. I could get both appointments for the 19th if I chose.

 

This vet has done TTA but the practice has been moving away from that surgery (which had been popular there for the last couple of years), feeling that TPLO provides a more stable result. A TPLO at this vet would cost about $2800, compared to a TTA by my vet at $1800.

 

So here's my dilemma. I think we can't get away from the conclusion that Celt needs surgery this time around. I can have it done with a TTA by my vet (who is admittedly less experienced being a younger vet and who is not, as far as I know, board-certified) in less than two weeks for $1800 (and this vet office provides rehab care so travel for rehab is not an issue). Or, I can have TPLO (most likely) done by the board-certified ortho vet in Pittsburgh in about four weeks for $2800 (and do rehab at my vet's office).

 

I know we've discussed the topic of torn CCLs and surgical options before, but I'd appreciate your input on this issue. Please feel free to PM or email if you have opinions that you would rather not make public.

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Hi Sue,

 

I don't have any information for you about the two surgeries, but I just wanted to wish Celt a complete and uneventful recovery for whichever procedure you choose.

 

Regards,

nancy

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No experience here either, but I'd like to echo what Nancy just said.

 

 

Best wishes for a smooth and swift recovery for Celt, whatever route you pursue!

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I guess you would have to weigh the expense vs. the possible outcomes...what would the worse thing be if your vet did it and the outcome wasn't as ideal?

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The expense difference is a consideration but it is not the issue, and my post was not clear about that.

 

For an active dog, I want what will provide the best outcome. I guess I'm just torn as to what is best for him and who is best to do it. I am so indecisive by nature, and always second-guessing myself.

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Hi Sue,

 

I am so sorry to hear about Celt. :(

 

I have no experience to share but wanted to wish you and Celt the best. Please keep us posted.

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Sue,

 

I would always go with the one with more experience. What happens if your local vet goes in to do the TTA and finds that really a TPLO needs to be done instead?

 

My choice of ortho vet will always be Canapp in MD. Recently had a dog have a luxating patella repaired. There were up to three different things that might need to be done, what would happen if another vet was only experienced in 2 of the 3? They weren't exactly sure what repairs were going to be needed until they actually opened up the knee.

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Hi Sue,

I posted about my experience with the TPLO earlier, you may have seen it. THe TPLO I had done on Hobbes at the age of 4 lasted throughout his long working life--and believe me, he worked hard, as my main trial/chore dog for many years. As a pointed out in my earlier post, the orthopaedic specialist who did the surgery was highly experienced and very well regarded. My vet told me frankly that the outcome was likely to be far better if I went to him than if anyone in his clinic did the surgery.

SO: I'd go with the more experienced vet too, especially one who has done many of these particular surgeries before. And indeed he may recommend an alternative procedure that the profession now feels is more successful--I may be out of date. However, to my mind anyway, the beauty of TPLO surgery is that they are not replacing anything: rather, they surgically adjust the angle at which the femur meets the tibia to optimum. (I think those are the two bones that meet at the knee!). So nothing to tear again.

A

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Thanks, all (and especially Andrea), for the comments.

 

Yes, I am certainly leaning very hard towards the more experienced vet. The feedback I am getting (here and elsewhere) also seems to recommend the TPLO over the TTA, as well - more stable, better for the more active dog, and so on.

 

I have a call into my vet for him to call me but I do believe that when he does, I will be telling him that I am taking Celt to Pittsburgh to the specialist. Also, rather than making the appointment there with the vet who saw him last time (who only does TPLO), I have made both the consultation and surgery (tentative) appointments with the vet who does do both, so that we can discuss the options and he can advise a choice, which I am quite sure will be TPLO from what the receptionist said.

 

She said that while TTA was popular for a few years, their vets are doing fewer of those nowadays and more of the TPLO. That says something to me about their feelings of which is the better option, even if it is more demanding (less simple) and takes more recovery time.

 

And, thanks, Andrea, I did read your previous post about this.

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No advice, just wanted to say I'm sorry you're going through this, and fingers crossed for a great outcome, whatever you decide to do.

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The TPLO involves a cutting and resetting of the head of the tibia to change the angles at which the joint's components meet (here is an excellent description). The TTA involves cutting and spacing the head of the tibia to utilize the larger ligament that passes from the femur, over the patella, and down to the tibia so that its tension is increased and it stabilizes the joint where the CCL no longer does so (here is a good description).

 

I like the simplicity of the TTA but from what I am hearing, the TPLO (while it may be a little more complicated and therefore may have a higher risk of something not being quite right), seems to give more stabilizing results when successful.

 

And, TPLO seems to be recommended more for active/working dogs than TTA. I think that, plus the experience of the vet, is the bottom line.

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Hi Sue, I have a 10yr. old 40lb lab mix that had the tradtional surgery done last July. He is extremely high energy, he does nothing slow. The ortho-vet that I used does all 3 of the surgeries but feels TPLO is over-kill for alot of dogs. All of the procedures rely on scar tissue forming to stabalize the knee, the tradtional is more fragile during recovery but the lines they use now are much much stronger. My dog was walking 3 times a day for 10 minutes at a time the day after his surgery, when he had his stitches out he was cleared for swimming and re-hab. At 9 weeks she lifted all restrictions, however I didn't let him fully off-leash till about 4 monthes out.

The reason I did not like the TPLO was if something does go wrong you have no other options, with the other 2 you can always do a TPLO if something happens. My dog is now back to normal, he runs like crazy, all I hope for is that the other one doesn't tear. He also has some arthritis in that knee so I would get Celt on some good supplements if you don't already.

Also, I would join Yahoo ortho-dogs, they have a ton of info and there are always people going through surgery at the same time, they are great about answering any questions or concerns you may have. Good luck with Celt. Cindi

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The ortho specialist I use is very highly qualified and experienced and favours TPLO. I trust his opinion and if I had an active dog I would choose that option.

 

I'm not sure if I would be happy having a normal vet try such invasive surgery, even if they do have an interest in orthpaedics.

 

I chose an extracapsular repair for my then 12 year old and it's worked fine in that he is as active as he was before, but he isn't a working dog and had already retired from agility because he was deaf.

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Thanks, Pam. I have a consult with the ortho specialist (with 20+ years of experience) in about 2 1/2 weeks (earliest I could get in with him). And we have a surgery appointment (tentative) scheduled for the next day. Since he has a boatload of experience (does probably 10 surgeries for this condition weekly) and does both TPLO and TTA (although he's getting away from the TTA as he feels the results of the TPLO are better and more stabilizing), I decided that was the best option for my dog.

 

Our local vet office has a rehab department and so we can get therapy here afterwards, which will be convenient.

 

I appreciate your input!

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Thank you, Kim. He is scheduled to be seen by the specialist a week from today, and the surgery is scheduled for the next day. I have already gotten the rehab lined up, also.

 

I have confidence in the plans we've made but I have to say I am very anxious, nonetheless, but that's just me.

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Sue I'm not sure if you know or are already a part of it, but there's a wonderful yahoo group called orthodogs that has a ton of members that are going through or have been through all kinds of dog ortho issues. Tiga tore his ACL about 2 1/2 years ago and that group was a wonderful source of support and information. I highly recommend it. Tiga had a traditional surgery done and it was successful. TPLO was not really an option around here, we would have had to travel. It was a long hard year of rehab but he's good as new now. My heart was in my throat for about the first 6 months. I was so scared his surgery would fail. I'm a nervous Nelly most of the time anyway and I swear I could feel my hair getting more grey everyday for a while.

 

The biggest piece of advice I can give you is to make sure you're prepared for his return home. We have all hardwood floors and I couldn't really afford to go out and buy a bunch of runners so we used yoga mats everywhere. We made paths so he wouldn't slip. I also recommend a sling if you have stairs. Tiga does not like to be carried so the sling was a great help. We live on the second floor.

 

If you have any questions or need anymore advice or suggestions feel free to ask. It'll be tough but worth it when you can let him off leash to run again. Hang in there.

 

ETA I also brought a yoga mat to the vet with us for follow ups as the floors there are very slippery.

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Thank you, Tammy! It is practical advice that is something I need. I have a friend nearby who had a TPLO done on her GSD last summer, and she has been kind enough to share some of her (so far, very successful) experience with me.

 

We do have carpet (old and ugly, but who cares?) which will help, and the vet office supplies a sling as part of the package. Fortunately, we only have two steps in and out of the house in either of the two doorways I'd have to use.

 

I have been steeling myself for this, knowing that the hard part will be the recovery, including the rehab and therapy work - but so many people have contacted me to tell me that their dog had this same surgery and, with dedication to doing the rehab/therapy after, their dogs have resumed a normal and very active life. And some of them had a much worse injury than Celt has experienced.

 

Meanwhile, he gets joy out of every unexpected special time - he particularly enjoyed sitting by my side while I cleaned the snap peas that I'd just picked, out on the cool grass in the lovely breeze this evening. And he's spent a while by my feet at the computer. I rarely have him out of the crate, only when I can make sure he stays put or he is on the lead going potty. He is such a goober that he gets silly and way too active unless I really am careful.

 

I keep telling myself that, in a very few months, he will be feeling much better and life will be getting back to normal for us both!

 

Thanks again!

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Life will get back to normal. There will be times when you won't think so. It's great that you have carpet and a sling. That will ease a lot of stress. The other thing to be careful of is if he normally gets up on the furniture. We kept all couches and chairs with pillows on the seats so he couldn't get up. Jumping on and off of things are a big no no. The biggest shocker for me was when I picked Tiga up. His poor little leg looked like a chicken thigh cause it was all shaved and it had a whole lot of staples. He also cried the whole drive home. I sat with him on the floor the whole day and night the first day he came home. There were times I thought he'd never be normal again. I really can't recommend orthodogs enough. There's a ton of useful documents on there as well on how to prepare for when he comes home and what to expect. Keep us updated on his progress.

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Thanks again. It is practical, everyday information that I need the most. I tend, like many others, to concentrate on the surgery and not be prepared for the nitty-gritty of the real life at home that comes either before or (especially) afterwards.

 

I am apprehensive but I know it is necessary and for his own good; that I have chosen an outstanding vet and rehab; and that this is a very successful surgery (and, sure, I know that problems can happen). While I know what I am doing is right, I'm still a softie and anxious about it all. That's normal, I guess.

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Everything you're feeling is very normal. I was the same way, focused on the surgery and not so much about what was to come at home. We got into a routine before the surgery and that was totally gone when he got home. I'm not sure you can ever be 100% prepared. The recovery process of the 2 surgeries is very similar but the TPLO is a shorter recovery period. Another thing is to always lean on the side of caution. If you think you're going too fast with him then you probably are. I read that he uses a crate. That will be helpful. Tiga is not crate trained so we just set up a little area in the bedroom and put laundry baskets and big things on the bed when we weren't there. We also made a barrier going into the kitchen because we didn't have enough yoga mats to do in there as well. If you have any questions or just need someone to vent to, I'm here and so are a ton of people on orthodogs.

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Thanks again!

 

He does have a crate although what we have been using for these last six weeks or so is an x-pen, reduced to a 4' x 2' size (his crate is 3' x 2') so that he has a bit more room to pick his place to lie down and to stretch out. He has a thick layer of sheepskin and blanket in there for cushioning.

 

He's got a night bed in the bedroom (and he stays put on that) but there is hardwood flooring in there, so I need to make arrangements for non-slip underfoot between his bed and the doorway there. I didn't think of that before. And he could sleep in the x-pen in the living room initially if that is better for him, and I can sleep on the couch or on the floor.

 

He's not one for getting on furniture but we'll have to make sure that doesn't happen. Since I will confine him whenever we're not home (and for all the time initially when we are), that shouldn't be an issue anyway.

 

There's just a great deal of this everyday detail stuff that needs to be worked out. I'm looking forward to him being sound again and able to enjoy life - this time in the crate, feeling left out and missing the fun, is not easy on him but he has been a real trooper so far. I think the Dan, on the other hand, would be letting me know in no uncertain terms that he was not happy if it was him in Celt's place right now.

 

Everytime he does get the least opportunity to vary the routine, like lying on the grass with me when I string the snap peas or brush him, he enjoys it to the fullest and I have to keep reminding him to not overdo it because he gets silly with joy about it all.

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Sounds to me like you're pretty prepared. X-pen is a good idea and moving it to the room you're in, or outside with you will help him for sure. It's challenging to keep BC's quiet, but he will have so much joy on that first run. I'm going to see if I can find the video of Tiga's first run post-surgery. It still brings tears to my eyes to watch it. Stuffed frozen kongs are a great way to keep him occupied.

 

Beware though, the most challenging part is yet to come. When he feels better but still doesn't have freedom. Tiga felt better almost right away. He wasn't using his leg at all pre-surgery and was weight bearing on the leg almost immediately afterwards. It didn't take too long before he thought he was ok. He still limped for about 6 months afterwards but now you can't even tell which leg it was.

 

Here's the link for the yahoo group:

http://pets.groups.yahoo.com/group/orthodogs/

 

And here's an interesting link about keeping them occupied while recovering:

http://www.lauriebryce.com/tplo/games2.html

 

ETA:

 

Here's the video of Tiga's first post-surgery run. It was at about 10 months post-surgery.

 

And his first swim at the lake post-surgery. This was about 15 months after the surgery.

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Tiga's and Celt's situation is a little different from the start - Celt is weight-bearing on that leg so, fortunately, it appears to have a good level of stability now and only a partial tear. He can scratch with it, stand on it to pee and poop, and there are times it's hard to see that he's not sound. But, where during the winter he would move apparently sound almost all the time, with just a bit of stiffness out of the crate, a little hitch in his stride that made me wonder if I saw anything or not, and the habit of standing with just the toes of that leg on the ground (when he should have been standing four-square), he obviously has a hitch now when he walks. So, things haven't gotten any better with the extended crate rest and Rimadyl, so the ligament is obviously damaged and not just strained any more.

 

I know it's going to take time - your time frame is a bit longer than the experience that my friend had with her dog (who only had a partial tear, 20%). But she thought her dog was going sound at a certain point, and the therapist had to show her where Anya (the dog) was just compensating with her good leg and was really not yet sound.

 

What my friend experienced with Anya (a GSD) is that while the vet wasn't going to release the dog for therapy until after her six-week check-up, the owner and therapist began it as soon as the staples came out, at two weeks after surgery. That's also what my regular vet's rehab facility does, starting with very gentle therapy, massage and stretching, laser, and so on.

 

When she took her dog back to the surgeon at six weeks, he was amazed at her progress and very pleased. He also noted that there were no adhesions post-surgery, perhaps due to the laser therapy combined with the gentle massage and stretching. He certainly was impressed by the quality of therapy she received. This therapist that I have chosen is certified but was first a human physical therapist and then also a canine PT, so she has a long and wide range of experience in physical therapy.

 

We're also prepared with out Bite-Not collar (thanks to Ruth!) and different sizes of cones (I hope to avoid those - not nice for any dog but particularly for a dog in confinement), two suitable crates (Celt's wire crate and Dan's bigger airline crate), and the x-pen. And sheepskins and blankets.

 

I've studied things out on the internet, in emails and other internet correspondence, and in talking with friends and acquaintances. I am very confident in my choice of vet and therapist - now what I have to do is have confidence in myself and follow the instructions we get so that I can do my part. I realize that the surgery is only a part of this, and that the follow-up work is just as necessary for success.

 

Celt will have his miserable times but in the long run, he will be a happy dog again, and able to do much, if not all, of what he has enjoyed doing before.

 

Thanks again!

 

PS - Thanks for sharing those videos. Tiga looks very happy and very sound. I am sure Celt will be ecstatic as his activities are resumed.

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No problem at all. The time frame is different with the 2 surgeries for sure. We started ROM exercises with Tiga at home almost right away. There is no option for rehab here so we were on our own. Tiga only used the cone of shame for a couple of days and only then when we weren't home. He didn't really try to dig at it much at all. You should be confident in yourself. You sound like you're much more prepared then we were.

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