An ACL tear and TPLO journal

[Sue R]

10 Nov 2012 - almost five months post-op and four full months of therapy

 

Another good visit. Walking and trotting around, you can’t tell that Celt had an injury or surgery as his gaits are quite smooth and symmetrical. He only occasionally stands with his bad leg extended and doesn’t rely on standing on his tip-toes on that leg any more, although the muscle memory of extending that leg is still visible at times.

 

Shari was pleased to show me and use a new piece of equipment, a Stage 4 cold laser. Because it is more powerful, we all had to wear protective eyewear to avoid any possible eye injury. Celt had no trouble adjusting to his goggles – Lisa said he looked like a regular rocketman!

 

 

Shari can tell that Celt is feeling good – he can get quite resistant during his ROM exercises. I think he finds them boring and repetitive. When he relaxes, he shows a full range-of-motion in most positions and it’s easy to do these but when he is distracted (like by the cat at home or wanting to get on to other things are Shari’s), he sometimes resists and I have to be patient in administering these.

[Sue R]

When I compare his early ROM photos to the latest ones (that I took in October), I can really see how far he has come in increasing his flexibility. Always a bit tight in the hamstrings, he is very limber otherwise.

 

Here is Celt, the eye-candy in the photo showing off the new laser equipment.

 

 

Here he is with Shari administering the cold laser to his front shoulder.

 

 

Celt’s other exercises went well – his two-legged dog is nice and steady so that Shari said I could increase that to six reps each side. He’s the “King of the Step-overs” according to Shari, doing them excellently (at 11” on her cavaletti) and so if I need to save a little time, I can reduce or cut them out for a session or two. But I don’t do that because it’s my favorite of his exercises – no bending over for me!

 

Celt never does very well on his back-ups but he has improved over time, from the very shuffling backwards walk of some weeks ago to the small-strided backwards walk of today. His sideways walk is improved a bit but he is not as flexible laterally with his bad leg as with his good leg.

 

He did well on the stairs – Shari has been concerned that he does a two front leg move at times but figured that it’s because I am in front of him and stopping, so he reads the pressure and stops. When I make sure to “release” the pressure, he rarely does that but walks the steps as he should. Another way her expert eye sees things and makes adjustments that I would not notice or think of.

 

His sit/stands are still pretty sloppy and not showing improvement in recent weeks. Shari showed me how to do them along a wall (or, better yet, in a corner) to encourage him to sit more squarely (rather than in a “puppy sit” with that one leg jutting out a bit to the side) and stand more squarely (rather than with that leg tending to stick out behind the good leg). The wall or corner limits him so that he can’t be so sloppy about how he places/moves his leg.

 

(At home, I have found a great corner for this. Between a dresser and room corner is a small area, maybe 15” across and deep enough that Celt can’t be lazy with his bad leg. I can see that he has to sit quite squarely, although he’s not perfectly square, and do the same with the stand. He picked it up very quickly and again, this may also be an example of having to overcome muscle memory.)

 

Before he went into the treadmill, we did our every-third-week thigh measurement. I think I was holding my breath since three weeks ago, he measured just one centimeter difference between his two thighs. She measured three times on each side, as she always does, and then re-measured his bad leg – just to make sure. And the difference was only ½ centimeter, another improvement.

 

Shari pointed out how important she feels the measurements are because no matter how he looks otherwise, this is an empirical way of finding out that he is (or isn’t) using both legs equally. He’s shown a steady improvement with most measurements over the course of his therapy, and that’s been a very good thing.

 

The treadmill work was improved from last week since I made an effort to do his walks more diligently but that still needs more improvement. He did three sessions of 4 ¼ minutes each. The first was excellent, he tired a bit in the second, and he did well in the third. It’s been a common thread throughout his therapy sessions that he will start well, get a bit tired and/or distracted and lose his “rhythm”, and then tend to recover and finish with better work.

[Sue R]

Our exercises for this week are pretty much the same –

 

Two walks a day of about 30 or so minutes each (with an added walk mid-day when I can do it), mostly on leash and as much walking (versus other gaits) as possible, as walking is the best gait for him to build strength, stamina, and symmetry in his leg muscles.

 

Two sets of stairs, twice a day.

 

ROM exercises, twice a day.

 

Two-legged dog, six reps on each side, twice a day.

 

Backwards walking, about 30-40’, twice a day.

 

Sideways walking, about 20’ each way, twice a day.

 

Step-overs, 12 reps, twice a day.

 

Sit/stands in the corner (I have the perfect place, between a dresser and a corner, where he has to stay pretty straight and square, and I can see how it makes him do this exercise correctly), eight reps, twice a day.

[Sue R]

17 Nov 2012 - almost five months post-op and over four months of therapy

 

No therapy visit scheduled for today - we were supposed to be on the Outer Banks for a vacation but Hurricane Sandy and her windy friends that followed have caused us to reschedule for next year. So, while Celt had permission from Shari for some water fun (fetching in the shallow sound water, water walks, and beach walks), that's not going to happen. I won't say how I'm feeling about vacuuming the house, doing laundry, washing dishes, and raking leaves in lieu of relaxing, having fun, and eating out at the beach...

 

One thing I have noticed during this week is that, along with improvement in the sit/stands (because we are doing them in a narrow corner "slot"), is that Celt is sometimes doing much better on the backwards and sideways walking. He's never done well at the backwards walking. Shari thinks there's probably a lot of muscle memory associated with his leg issues although he has made progress from his early-on shuffling to taking small steps backwards.

 

But this week, several times, I've seen him apparently stepping backwards with a bit of a reaching stride on both sides. And his sideways walking is improving also, being less of a shuffle and more of a side-step.

 

He's enjoyed some good, long walks and time off leash; yard time when we are raking leaves, and a pretty active week without any noticeable signs of stiffness or short-stride in that leg, so I'm happy with his progress.

 

We are continuing with the program for the next two weeks until we get to see Shari again. Happy Thanksgiving, everyone!

[Sue R]

1 December 2012 - 5 1/2 months post-op and almost 5 months of therapy

 

It has been three weeks since Celt’s last therapy visit with Shari. We were going to be gone to the Outer Banks on vacation including two Saturdays but, thanks to Hurricane Sandy and the Nor’easter that followed and high winds, access to the banks was limited. The folks who were renting us a house were kind enough to let us reschedule our trip there, and so we stayed home a few more days and did yard work, and then drove down to NC (with an overnight stop near DC with our son and family both ways) to spend about four days with our daughter and her pack of three dogs.

 

So, while I was able to implement Celt’s routine of walks and exercises for the first week after his last appointment, and most of the week previous to this appointment, things were a bit disrupted in between those weeks. Down where Lisa lives, it is pretty flat so we missed our hill walks. While I don’t always appreciate the hills here, they are great exercise and therapeutic, both uphill and downhill. And, since I couldn’t bring along some of our at-home exercise equipment (the cavaletti), we just weren’t able to do that. In addition, some of the exercises that go well at home because we have our routine and our “arrangements” (like walking backwards and sideways), just didn’t seem to go as well on unfamiliar surfaces and without our familiar hallways and locations. And, to be honest, we probably only did exercises once a day rather than twice. So I was a bit apprehensive about whether or not Celt would show any improvement in strength, stamina, and balance in spite of it being three weeks.

 

After Shari observed him just walking and trotting around her rehab room, we took Celt and a ball into the next-door agility room, where there is a surface that has great traction and is cushioned, and she had me roll the ball for him a bit. I wondered why she had us do it as much as we did, maybe a dozen times or more – but what she was particularly observing (other than his gaits) was whether or not he was pivoting evenly in both directions, which he was.

[Sue R]

After this bit of an aerobic workout (for a dog that has not been playing at all vigorously, it was a workout), she stopped to measure his thighs – and we were both surprised at the results. While his “good” left leg measured 37 cm (2 cm more than three weeks ago), his “bad” right leg measured 38 cm (3 ½ cm more than three weeks ago). The improvement in terms of increased muscularity was expected and hoped for. The greater size of the right leg (1 cm) compared to the left was unexpected.

 

Shari admitted that she should have either measured him before he exercised in this way, or after his ROM and cold laser. She also postulated that this result could simply mean that he is having to use that leg slightly differently to compensate for the change in angulation due to the surgery. So, it will be interesting to see how he measures three weeks from now. Like many other dogs who start out therapy wanting to be close to *their* person, Celt has become very secure and relaxed with Shari’s handling. I doubt he’d stay put on the mat with her if I got up to leave but as long as I’m nearby, he’s quite content to relax with his head on her leg while she applies the cold laser and does the ROM exercises. I could get jealous…

 

 

Celt did well on all his exercises – pretty much fully flexible in all his passive range of motion; steady and well-balanced on his two-legged dog; a little better on his backups, showing a little more willingness and ability to step back rather than shuffle back; better on his sideways walking (reaching further under his belly with both legs to the point that he would place one foot in front of the other fairly frequently, and even crossed over a few times, showing much better ability to be flexible and reach); stepping over the cavaletti at 11” equally well with either hind foot leading; and walking up and down the stairs with no apparent difficulty.

[Sue R]

Shari had the underwater treadmill set at 1.2 miles per hour and had him do three sessions of 4 ½ minutes each (when we started that very first day, over four months ago, it was about 0.8 mph, so that’s an increase of 50% in speed, and 2 minutes each, an increase now of 250% - so, overall, that’s a huge increase in the workout he is doing).

 

He did his first session without tiring but I noticed him occasionally sniffing upwards like he was catching a scent or seeking a scent. And, instead of holding his ears to the side like he tends to do, he was often flicking an ear back towards Shari, as if he was either hearing her saying something (which she wasn’t) or expecting her to say something. He was also flicking his ears in my direction. And he was occasionally just stopping and riding the belt backwards, like he was distracted.

 

I asked Shari what was wrong with him as he should not have been getting tired. She said, “Welcome to the stage where he’s feeling so good that he’s getting bored of this!” And that’s just what it was – he was not having to work hard at it any more, not having to concentrate, and not content with just walking along when there could be something else more interesting going on.

 

He began to show a little tiredness partway through his second session, maybe at about 3 minutes and was, of course, a bit more tired for the last session, and so we did not see any more of the lackadaisical activity of the first session. One thing I did notice, sitting out in front of the tank, was that his face never got anxious in any way – he was never struggling at all, just being naturally tired at times, and his face always stayed “happy”.

 

 

Celt has a real tendency to walk on his right side of the tank. Shari often has her hand down between him and the side of the tank to guide him from stepping on the stationary edge (which he has only ever done once or twice). I asked why he does this and she felt that since he relied more on his left leg for support for so long, that he naturally orients himself so that that leg is closer to the middle of the tank.

 

[Sue R]

Done with our session, I was ready to ask Shari if we were at a point where weekly visits were no longer needed but she beat me to it, saying that I did not need to reschedule for another three to four weeks, and then probably one visit about four weeks after that. And then, if all went well, no more visits unless we had a problem or I chose to bring him in for some cold laser, evaluation, and underwater treadmill.

 

Shari told me at the very beginning that a “normal” rehab recovery period for this type of surgery was about three months. So here we are at almost five months but we had a couple of additional challenges to overcome – one was that Celt had been on very limited exercise for a couple of months prior to surgery, so his entire body was very unexercised, along with his surgical leg being very atrophied. A dog that suffered an ACL injury and had surgery reasonably promptly, would have much less recovery time needed because his/her body would have already been in a “normal” stage for that dog.

 

(There is an upside, though, to Celt having been on such limited exercise for the several months between when I was pretty sure that he had an ACL issue again and the surgery - since I did wait that long (partly to try conservative treatment again, partly to conduct some tests, and partly because of the surgeon's busy schedule) it was good that he wasn't overactive because, after all this, there was no meniscal damage found by the surgeon. So, while more activity *might* have provided some physical conditioning (although it would have been very uneven conditioning, with the bad leg atrophying and the good leg maybe bulking up due to overuse), it might have had the downside of damaging the meniscus.)

 

In addition, Celt experienced a set-back when I fell and his ileopsoas muscle was hurt, and that episode put us back over a month in his progress. Taking these two issues into account, Celt is just about where he should be in terms of his recovery progress.

 

Some dogs of Celt’s age, showing a little bit of arthritis (which he certainly has to a small degree in that knee, and may have elsewhere) may benefit from the cold laser, and so that’s an option I can keep in mind for the future.

[Sue R]

Meanwhile, we are to continue our at-home exercises as we have for the last month or so, but increasing his aerobic activity – he’s cleared now for some ball-playing, and I should replace some of his leash-walking with off-leash activity, where he can run and develop some stamina. Walking is still excellent in so many ways but he does need to increase his ability to run and work harder.

 

Since his previous visit, I have been trying to walk the dogs about 40 minutes twice a day when I am not working, which includes some good hills and about 10 minutes of off-leash for Celt. On workdays, I only get in about a 20 minute morning on-leash walk but try to get 40 minutes done in the evening.

 

I’m carefully introducing some play with the ball, keeping it limited – fortunately, Celt does not dive for the ball when Dan is also playing like he would if Dan was not playing, but he still does a good bit of running and has an enjoyable time. And I’m devoting a greater proportion of his walk time to off-leash – sometimes, he runs a bit more and sometimes he is content to walk and trot along near me, but it is increasing his workout because, off-leash, he covers more distance than on-leash.

 

And, Shari thought, by the time we start to calve in earnest in March, he should be ready for some stockwork, taking it carefully at first and building up as he shows he can do the job again. He thinks he's ready *right now*!

[Sue R]

21 December 2012 - six months post-op

 

It's a funny feeling as things are winding down in Celt's saga (and, with my wordiness, saga is an apt description). We've got our planned next-to-last therapy visit in a little over a week, and it's been 2 1/2 weeks since his previous visit.

 

Our days have their own routine - on the days that I work or are otherwise pressed for time, he gets his morning in-house exercises as outlined above, and the dogs and I (and usually Ed) take a brisk 20-minute walk, which involves some hills and some flatter ground. He's no longer on leash for the walks so he does a mix of walking, trotting, and running. In the evening on work days, the dogs get fed as soon as we get home, they get about 10 minutes of ball play (I eased Celt back into this and, since he tends to hang back when playing with Dan, he does little diving, just mainly some running to build up stamina and speed), followed by a 40-minute walk. Again, that includes hills and more level ground. Level is good but the hills are really beneficial, building strength and balance. And then we do his in-house work when we get home from that.

 

Days where I don't work usually involve pretty much the same routine except that the morning walk is often 40 minutes long like the evening walk, and we do a bit of ball play on the way out to walk.

 

What do I see in Celt now? I do not see any limping or irregularity in stride at any gait. He seems capable of walking, trotting, running, racing, and jumping without any issue. He is full of energy and enjoying life again. He is very muscular - the exercises have really bulked up his thighs which is not (in my opinion) really a Border Collie trait. Compare a sprinter with a distance runner and you will get what I'm talking about.

 

As he feels better and better, he can get sillier and sillier when it's exercise time - he's bored with the ROM and lets me know which exercises just don't appeal to him - and he's got the strength and attitude to let me know that he'd rather be doing something else, but he still has to do what Shari has prescribed.

 

At this point, Shari has said that a missed session is not a big deal and so he does not get his in-house exercises once or maybe twice a week, when life (or laziness on my part) gets in the way.

 

Our goal is that he will be ready for calving season. I think he's probably ready now but we've been very cautious - working cattle, rough ground, winter weather (wet ground, mud, rough and icy ground, etc.) - we'd just rather be safe than sorry. And Dan has been able to help with the few jobs we've needed help on this winter.

 

It's been a long haul and yet it seems like time has flown by.

[Sue R]

27 December 2012 - a little over six months post-op and 5 1/2 months of therapy (20th visit)

 

This was our next-to-last planned therapy visit with Shari, so it was a bittersweet one as I have always looked forward to and enjoyed our sessions. For that reason, I hate to see them end and yet approaching the end of this phase of Celt’s recovery is also a very good thing as it means he is getting close to resuming his life as he likes to lead it. The only thing he is not doing at home yet is working cattle, and Shari expects him to be prepared for calving season in March.

 

We spent the last 3 ½ weeks doing all the usual PT in-house exercises as we’ve been doing them for a while now. Outside, we have been working at getting in a minimum of an hour and up to an hour and a half of walking a day, entirely off-leash now. Also, when the ground conditions allow, we’ve also included Celt in ball play, where I use the Chuck-It and a field with a convenient dip in it (to provide flat, uphill, and downhill work) for all the dogs to get some aerobic exercise.

 

Since Celt does not dive or jump when Dan is playing, but does do a bit of running flat out, pivoting and turning, and starting and stopping, it gives him a chance to exercise in an aerobic fashion with minimal risk. I could do this better if I was in a position to be biking with the dogs (or had a small scooter or four-wheeler) so that they could get steady trotting and running, but that’s not feasible here. In milder weather, I would be able to ride my bike for parts of the walk routine, and I hope to do that in the future. While Celt has gotten stronger and more evenly balanced with all the walking, he needs to build some stamina at speed, especially before he works cattle again.

 

The visit today was very positive.

 

We started out at first with observation, as always. Celt was full of energy and showing no stride issues at any gait or when turning or sitting. Then Shari did the ROM and cold laser. I don't realize just how far he's limbered up until I compare photos from today with photos from our first session.

 

Hamstring stretch -

 

 

Hind leg thigh stretch -

 

 

Front leg/shoulder forward extension -

 

 

And front leg/shoulder backward extension -

 

 

After Shari did the ROM with Celt, along with the cold laser therapy, she measured his thighs. For the first time, they measured perfectly evenly (38 cm). She made sure to do the measurements when he was relaxed and not right after he had exercised actively, and got a good, true measure of both thighs. This measurement is very important because, no matter what else we are seeing, it is a quantitative measurement that avoids all subjectivity – and, frankly, it doesn’t lie.

[Sue R]

His two-legged dog brought a big smile to Shari’s face – strong, solid, balanced, even, no problems.

 

Balancing on the "good leg" diagonal -

 

 

And balancing on the "bad leg" diagonal (where he is always a little more concerned, and you can see that in how he turns his head) -

 

 

He still is not the king of backing up and never will be, but he’s comfortable doing it and does it without difficulty, even though Shari would like to see him reaching back with both hind legs. Even though his strides are short, they are not shuffling anymore and his hind end is strong.

 

We did the sideways stepping and Shari’s primary remark was wondering if he did it better at home. Like the backing up, it will win no prizes, but he does both of these a bit better at home on carpet, where he likes the surface feeling better.

 

He was an ace at the cavaletti/stepovers at 11 inches – not a mis-step in his first run-throughs, and so we did it again just because he enjoys it and does it so well. As she said, no problems with this exercise!

 

We did steps and he was good with those, and he’s been doing well with them at home. I don’t need to stand half-way down anymore but I can stand at the top, send him down, and then call him back up again, and he does well.

 

Our assignment for the coming four weeks until our next (and, hopefully, last) visit is to continue the exercises as we’ve been doing since he’s at the max for benefit at the levels he’s at now. We are to keep the walks at the current level, can walk more anytime we’d like, and to try and keep up the aerobic exercises and increase them as the ground conditions allow.

 

All in all, a very positive, happy visit with Shari – I can’t say how grateful I am for all her help and efforts over these months. It’s been great to be guided by someone who is concerned, experienced, listening, communicating, and open. I couldn’t ask for better assistance.

[Sue R]

Lisa, our daughter, brought her 11-year old Nellie (and ACD-cross) along for a visit. Nellie has been experiencing some pain and has some arthritis, so Lisa asked Shari if she would be willing to take a look at Nellie and perhaps draw up a plan for some in-home exercises that might help ameliorate Nellie's discomfort. We were both pleased when Shari said she'd be happy to do that, and that Lisa could call with any questions between the twice-yearly visits she might be able to make in person with Nellie.

 

Lisa supplied Shari with Nellie's xrays taken about two years ago for reference, and Shari got to work with Nellie, which sounds easier than it was as Nellie is a very "skeptical" dog about non-family. Between watching Celt's full appointment and wandering around the therapy room, and Lisa and Shari's careful and experienced handling, Nellie was able to receive a thorough evaluation, cold laser, passive Range of Motion, and a few other exercises (backing up, which will be a challenge), and both sitting and standing high-fives. Her routine is primarily stretching, improving range of motion, and hind limb strengthening.

 

Shari again reiterated how important hand placement is in executing the ROM exercises properly, so that they are beneficial and never harmful. The hands never *pull* on a limb but are placed to either support (like the hand on the lower front leg in its extensions) or to *push* (like the hand on the elbow in the forward front leg extension). You can see how Shari places her hands in the photos above, and also in the photos taken early in Celt's sessions.

[WildFlower]

Thanks for keeping this up to date Sue.

 

It has been so informative and I think it will be a great resource for many people who encounter the same situation.

 

It's wonderful to hear of Celt's progress!

[Sue R]

Thanks, it's very nice to know that there are people who have read this and appreciate it. I know of several people who have been faced with a similar situation and have found it useful, and that is what I had hoped for. Plus, I have also used it as a reference (although I do admit that I have the "original manuscript in hand, too).

 

Thank you!

[Tiga's_mom]

This is a great resource for sure. It would be a great archive to the Orthodogs group as well I think. Your story is very detailed and will be a great help to anyone going through this. I often wish I had kept a more detailed account of Tiga's experience. Thank you for doing this and I'm so happy to hear that Celt's life is getting back to normal. You've done a wonderful job re-habbing him.

[Sue R]

Thank you, I appreciate your kind words!

 

Right now, we are looking at (hopefully) just one more visit, in two weeks' time. If all goes well then, Celt should be cleared for going back to work on cattle.

 

He seems to be the very picture of health, soundness, and vitality right now. He's fit, active, and not acting like a common 10-year-old dog.

 

I have to admit that I have been very slack during these dark days of winter following the holidays. On my work days, and on some other days, I have only done his indoor exercises once a day, but have continued to faithfully do his walks and outside exercise. Most days, we do a minimum of an hour of dog walks, which for him involves whatever pace he chooses to set - walk, trot, run, sprint - since he is off-leash unless there is a need for all the dogs to be on-lead.

 

I do try to do his indoor exercises twice a day on days that I don't work, but I too often find myself pre-occupied with other things and tend to forget doing them in the evening. I really need to make the effort to make them a priority again.

 

I will be interested to see how he does at his next therapy visit, particularly since we've been doing lots of outside exercise (the snow that covered the ground for a while now has made our walks much longer and much more challenging) while I've neglected the twice-a-day indoor routine and mostly done it just once each day.

[Sue R]

A little on the light side, just a few photos to show how much Celt has returned to a normal (or what passes for normal around here) existence.

 

Here is Celt (along with Dan and Megan) and myself on New Year's Eve morning. We and Lisa, my daughter, and her three dogs, took our dog walk up to the top of the neighbors' upper hayfield, where we can look out across the fields and hills to Chestnut Ridge, about eight miles west of our farm. With good footing, this is a 40-minute round-trip walk. With snow, it takes about an hour, and more if the snow is heavy or deep.

 

 

Celt and Megan playing with the Flying Squirrel in the yard. Celt has just dropped the squirrel and Megan (the only good retriever in the pack) is on her way to bring it to me, while he dashes off to set himself up for the next throw.

 

 

Dan is the one who gets the ball or squirrel on most throws, being the fastest but also the boldest in the pack. He's a sometimes-fetcher, so here he is bringing the squirrel towards me, with Megan ready to pick it up when he drops it, and Celt coming along behind.

 

 

Not all fun and games are aerobic - playing "cat in the box" takes patience and mental energy, but not much physical energy!

 

[Sue R]

15 January 2013 - just about seven months post-op and six months of therapy

 

Just a brief note - Shari called to reschedule Celt's appointment (hopefully, his last one) which was on the calendar for Saturday, the 26th. I "confessed" that with the short days, busy time at work, and just being a slacker, I was only doing his indoor exercises once a day, even though I was keeping up with his at-least-an-hour of walking and ball-playing daily.

 

She thought on that for a moment and asked if he was showing any indication of gait issues, pain, stiffness, or other problems and I told her honestly that he seemed to be jumping out of his skin with good health and soundness, full of energy and activity.

 

She said that, since that was the case, I could continue doing the in-house just once a day if that worked best for me and we would see how he did at his next appointment. That's a relief for me because I've just not had the ambition in the evenings as some of the activities are strenuous on my back after a long and tiring day.

 

She pointed out that the goal is for Celt to be active and exercised with his natural walks and activities so that there is no need for continued in-house exercises. They are part of the means of getting him where we want him, and not an end-goal in themselves. So, one of these days, those may not need to be a part of our daily routine but, for now, we are continuing with them to help promote his overall soundness, strength, balance, and stamina. And, the added bonus should be help reduce the likelihood of the other ACL tearing someday.

 

It's been a long haul but we've been very conservative in his rehab. At 9 1/2 years of age when he had his surgery, he is no young dog - but you sure can't tell that watching him run and play now. And, soon, he will be putting his skills back to work as our cattle enter the calving season.

[Sue R]

19 January 2013 - exactly seven months post-op and a little over six months of rehab

 

Today was a red-letter day. Our next (and hopefully last) therapy/rehab appointment was not scheduled until next Saturday, and is now unscheduled until Shari and I can find a new date that we can use. We needed to gather the cows to treat for lice, which have begun to get active with the short days of winter. I knew I needed a dog to help move cattle on this milder, perfectly sunny, but blustery day, but I just did not feel up to using Dan (particularly with the cow with the twin calves). I decided to go ahead and give Celt a chance to do a little, simple work.

 

Dan was quite put out when I crated him and let Celt come with me, and Celt was beside himself with anticipation. When we got out and behind the house, the older cows were already filing along the fenceline on their way to the working pens. We waited for a hiatus in the progression and walked out into the house field. There were some animals on both sides of the fence separating this field from the south hayfield, where they were feeding on the big round bales. Gathering them would call for a dog that would look, observe, and think in order to get both groups moving in the right direction, coalesced, and moving to the pens - and, while the mother cow was already in the pen and getting some supplement, her calves had been left behind with the stock at the hay bales.

 

Along with the two young calves were the first-calf heifers, the two young steers from last year, some of the younger cows, and the one old granny cow (who is fifteen, and very slow-moving). This would call for finesse, the right amount of pressure and balance to get them all moving where we wanted them to move, young, old, and in between. I was glad to have Celt for my partner, as Dan is not my choice for finesse.

 

I sent Celt away and watched as he went on a nice outrun, adjusting his path for the terrain and natural obstacles, and stopping a little bit short at around 3 o'clock, on the near side of the fence, as he observed cattle on both sides. He was aware that he needed to move both groups along the fenceline towards the gateway east of where they were located but I think he was concerned that if he crossed the fenceline to move those in the south hayfield, that he might lose control of the ones in the house pasture.

 

I gave him two short flanks, both of which he took, to place him closer to the fence, and the two or three on our side of the fence began to move eastward. Good. One more flank command and he slipped through the fence and began walking up on the bulk of the cattle nicely, and turned them eastward. But these cattle have not been worked by a sensitive dog like Celt, not for most of a year at least - they've been worked by Dan and I could see that in their reaction. "DOG! Moooove out, girls, he's coming to getcha!"

 

Celt, who can have a real issue with flying around to the heads (which is something we have struggled with over the years, and which has improved quite a lot) just kept up a nice, steady, right on the bubble pace. He moved all the animals along the fenceline, flanked himself to put them through the gateway, and was walking them very nicely on their way to the pens. At that point, while I hated to do it, I downed him a few times to take the pressure off the old cow, who was moving as fast as she could, trying to keep up with the others. Fortunately, he was on his best behavior, taking my stops and not pushing her unduly.

 

When he got the herd to the pens, he hesitated - Celt is extremely pressure-sensitive and it's very hard for him to push stock when there is a lot of "back pressure", or pressure from the pens or a fence corner that is "pushing back" on them. Ed encouraged him to walk up and the ladies complied, with all but one moving nicely counter-clockwise to be in a good position for moving into the pen. Celt and I walked around and we both worked to move them quietly into the pen.

 

I really wish I'd had it all on video because he did a very nice job, hardly any input from me as he knew what needed to be done and he did it beautifully, but I can barely walk and chew gum, and so did not have my camera along. If I'd know just how nicely he was going to work without me having to do much of anything, I could have done it but I just didn't know in advance.

 

So here's the only picture I did get, a contented dog looking on the fruits of his long-anticipated first-time-back-on-the-job -

 

 

I didn't want to push my luck and we used Dan to help move the older cows (minus the first-timers, the mother and her babies, the old granny, and the two steers, back to the south hayfield, across the road and into the south driveway pasture, and then across the driveway, into the south barn field.

 

So, nothing in this post about rehab, just sharing our excitement at using Celt on the cattle for the first time since his surgery. It's a mighty good feeling.

[Sue R]

29 January 2013 - seven months and ten days post-op, and six and one-half months of therapy

 

This was the day we've been working towards, Celt's last scheduled appointment with his therapist, Shari Facchine, at Woodlands Animal Care Center. This was the day I wanted to hear Shari say - well, let's just see what happened.

 

I had some concerns - for one thing, since our last visit, I had cut back on his in-house exercises from two sessions a day to one session a day. Shari knew this and we both knew that today's visit would let us know if that was a wise decision, and if I needed to return to the twice-a-day regimen or if once-a-day (or maybe even less) would yield the desired results at this point in his recovery. I have been faithful in doing the walks and outdoor exercises - a minimum of an hour in total a day (either a shorter and a longer walk on workdays, or two longer walks on at-home days). The dogs are all off-leash, walking, trotting, running, sprinting, chasing, whatever they choose. Plus, we usually play some fetch, either with the Chuck-It or the flying squirrel, as either part of the walk or additional exercise. I wondered just how the cutback on the in-house exercises and the expansion on the outdoor exercises would reflect in Celt's evaluation today.

 

A little bit of outdoor fun with the flying squirrel (Megan in attendance as she's the Queen of Fetch and Celt is the King of No-Fetch) -

 

 

Shari watched Celt as she always does, walking and trotting around, just being a dog and being totally natural. And then she jokingly asked me, "Is this the same dog that had surgery on his knee?" At that point, I knew he was looking good and she was feeling very positive about where we were at this point - but, until she actually got hands-on, made him work, and watched his responses, we would not know if this long period comprising diagnosis, surgery, and rehab/therapy was completely successful in restoring Celt to his position as a working farm dog.

[Sue R]

Cold laser and the passive range of motion (ROM) went well. Shari found him to have full extension on all four limbs. She noted that his thighs felt very muscular and she proceeded to measure them right after the ROM, the best time to get an accurate measurement.

 

He measured at 39+ cm for each leg, nicely even - and a little more than a centimeter increase since our late December visit. That surprised me as I thought the in-house exercises (particularly the stairs and the sit/stands were the most likely to be "bulking up" the thighs as they are particularly good at strengthening those muscles. And I thought the running outside would increase fitness but not necessarily be reflected in an increase thigh measurement. Apparently, I was wrong.

 

All the dogs (and I) benefit from daily walks up the road and up onto the neighbors' hilltop hayfield -

 

 

Shari went back to her notes to tell me that, at his first visit, his normal leg had measured 34 cm and his surgical leg only 30 cm, so that is quite a change. Of course, his original measurements had come after about three months of very restricted activity, and so were much reduced from what they would have been back when he was sound previously. This was a huge improvement.

 

Shari easily got full extension on Celt's legs in the two-legged dog exercise, and his on-the-ground legs were steady and strong. She makes doing that exercise look so easy, and I seem to struggle with it. My renditions are certainly not so graceful in appearance but they must have been reasonably effective, nonetheless.

[Sue R]

Celt did his backups. He does them readily at home where we have a hallway arrangement that encourages a fairly straight backup. At Shari's, he was tending to curve towards his right (the surgical side) since we did not set up a chute this week for him. Since he finished up with some very nice, straight backing, and since, at home, he does not consistently back unevenly (he may go straight, curve left or right), she felt that it was myself and his surroundings that were probably causing any unevenness. All in all, he looked good and comfortable in this exercise.

 

He did his stairs well. It's really harder to judge at the clinic because the full-size stairs are only four steps tall. I can see at home, where we have 10 or so steps, that he can go down and up with ease and good control.

 

His sideways stepping passed inspection, although that's the hardest exercise for me to do with him, since I am both bent over and walking with him. His feet come under as far as the foot on the other side, and he even steps across past the other foot - so there is flexibility and strength evident, when he relaxes and uses himself properly. It's just a hard exercise for me to do and for him to comprehend.

 

Just before getting into the underwater treadmill, Shari checked his sit/stands, and was pleased to see that he was quite symmetrical. Not perfect but very acceptable. Again, this is something that he did "wrong" (compensating for that joint) for some time and, with the change in angle due to the surgery, he may never sit entirely or consistently evenly.

 

And Celt figures it's always a good time for a treat, and he knows just where Shari keeps them -

 

[Sue R]

A red-letter day in hydrotherapy - Celt did three sessions of five minutes each, at a pace of 1.2 mph. Three five-minute sessions is the goal Shari has for a recovering dog. When the dog hits that level of strength and stamina (at the right speed and water level), she considers that dog to be recovered (other indicators being positive). Shari chose that speed because it causes Celt to use a stride length that she feels is optimal for this exercise. She lowered the water level just a little bit more - that reduced the buoyancy a bit more and made it just a bit harder walking.

 

It's counterintuitive to me but think of it this way - if you walk in waist-deep water, the water is supporting a good portion of your body weight. You don't raise your feet very much at all, and you can walk quite comfortably at an easy pace for quite some time. But if you walk in knee-deep water, you do not have very much buoyancy at all provided by the water, and you tend to lift your feet and legs in a higher step, which makes it physically more challenging and much more tiring.

 

You could see the difference by watching the water in the tank - at today's water level (the lowest he has experienced but still not far below his elbows and about mid-stifle), his walking set up tons of small waves in the tank. The deeper the water, the smoother it remains. Also, with the turbulence caused by the lower water level, there are increased demands made on the legs, making this even more of a workout.

 

Celt did very well, getting a bit distracted every now and then (he finds this quite boring now that he does not have to concentrate to keep moving like he did earlier on when it was still quite an effort), but staying strong and steady. After the second session, we could see that it was a workout by his respiration, which was elevated for a few minutes. Workout or not, he was up to doing the job.

[Sue R]

I noticed something and I feel bad that I did not get a video or some photos but I had the camera going alongside the tank to record him from the side. It seemed to me that his hips were slightly uneven - there was just a very small, hardly noticeable difference in height, with the hip on the surgical (right) side looking just slightly higher than than on the left side. And I noticed Shari reaching down and touching the high point of his rump (where I could see the difference) several times. She also, instead of watching in the mirror set up near his head), was looking right down on his rump/rear end and observing.

 

So I asked her about what I thought I'd seen, not only the slight difference in height of hip but also a little, hardly discernable difference in how his hips moved. And she said that, yes, I was seeing both of those things. Because the surgery alters the angle of the knee joint, that may be reflected in both the height of the hip/rump and in the movement of the leg.

 

But, she pointed out that each leg was working well in and of itself; his strides were quite even, with the right leg moving maybe just a hair less forward and a hair further backward on each stride; and both legs were *working well together* (and the evenness in the thigh measurements reinforce what we were seeing here, that the legs are being used very evenly) which is what we hope to see.

 

When I think about the change in angle in the knee joint, I can readily see why Celt's "altered" leg strides a little less forward and a little more backward than the "non-altered" leg. The altered joint is now more level. Reaching forward is more restricted and reaching backward is less restricted than in the normal leg, even though both legs show similar passive range of motion. Both legs stride a similar length but a plumb line would show that they stride slightly differently in terms of forward and backward. And that is also reflected in the slight difference I see in hip motion between the two sides of his rump.