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An ACL tear and TPLO journal

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Sue, I forgot to mention about the massage. Always stroke towards the heart. Correct massage aids mightily in increasing circulation of both the blood and lymph fluids. Since that is what is carrying away the damaged cells and bringing healthy stuff to repair tissue, massage is a great idea.

 

Fresh blood also carries oxygen, so a little massage before movement can really make the first-thing-in-the-morning stiffness and pain much less.

 

And the remark in my previous post about ortho surgery was meant to be amusing. I know that what Celt has gone through is a much bigger thing than aches, sprains, etc. Forgot to put my smily face in, so here it is :)

 

Ruth and Agent Gibbs

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My JRT did the same leg carrying when moving faster. Her muscles on the injured leg had atrophied so much that she had less strength and speed on that leg. Post surgery, she didn't start using that leg as well as I had been led to expect. Once we started therapy, which for her was mostly a lot of swimming, she made slow but steady progress, until today when you would never know she had had an injury except for the little bit of a scar. Her surgery was 9 months ago.

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As a rough time line, for us, Tiga stopped limping when his hair grew back, so about 6 months. He 3-legged it for quite a while when he was trying to go faster.

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June 25 2012 - 6 days post-op

 

I have been emailing back and forth with my friend, Cindy, who had the TPLO done on her GSD last fall. My experience right now is that Celt is most likely to use all four legs when going very slowly and without the sling (and using all four legs if he is capable seems to be the safest option for his other, sound leg). He is beginning to use the fourth leg when the sling is on as of today, as long (again) as he is going slowly.

 

My goals are to keep him at a slow enough pace when going out to do his business that he will use all four legs rather than three. That is a challenge when he really has to go, as in the first trip of the morning, but I am working on setting the pace by setting my pace, using the sling when needed, and avoiding having him pulling on the leash (which he will do when over-eager because he has to go *now*).

 

I think he's doing well - a bit of swelling at the top of the incision is virtually gone now (it was quite obvious a few days ago); the incision remains dry and healthy-looking, and apparently healing; the cone is working well to keep him from licking the incision; the bruising inside the thigh is almost entirely gone (at least visibly gone); there is no edema on the lower part of the leg any more; and the redness on the skin on the lower leg is fading.

 

When he walks, sometimes he seems to be walking a bit pigeon-toed on both hind legs and sometimes he seems to be walking quite a bit more straight. The walking is getting less and less pigeon-toed and more straight each day, I believe.

 

He's cheery (too cheery, sometimes) and I'll be curious to see how he does as his last dose of Tramadyl is in the morning, although he has a few more doses of Rimadyl left. Meanwhile, he's enjoying his private time enormously. We do his potty business and stroll around part of the yard for about five minutes, then his massage and ROM, and then come in for his cold compress. And he's enjoying his treats that come with putting the cone back on, and seems rarely reluctant to have me put it back on.

 

I'm being very careful to keep Dan and Megan confined to crates or elsewhere when Celt is out of the x-pen, and so we have had no issues. Celt needs to get over his resource guarding at dinner time but that's a bad but ingrained habit at this time, and I just have to manage it to avoid him stressing his legs. Dan, bless his heart, is doing nothing to deserve Celt's defensiveness.

 

I spoke to the vet office and they said to continue the cold compresses until the vet sees Celt on Thursday, at least. I think he's far enough along that warm compresses might be more relaxing and beneficial, but I'm doing what they instruct right now.

 

Night all!

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Thanks for journaling on Celt's progress, Sue. You're doing a great service. I've been following since you made the decision and it sounds like things are going as well as they could be. Best wishes for continued success with Celt's rehab!

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June 26 2012 - one week post-surgery

 

Is it already a week? At the beginning of this journey, I looked forward to the immense amount of time that was mapped out in front of us and shook inside. And yet the first week as gone by, like all weeks, pretty quickly - even though individual moments and events sometimes seem to drag out. On the other hand, I feel like I've been doing this forever with Celt.

 

Progress seems uneventful (thank goodness!) and slow but steady. He is using all four legs more and more, but still particularly when he is moving more slowly. If he's excited or I forget and let him move a little more quickly (still walking), that leg will come up and he'll rely on the sound leg.

 

It is important that he uses the leg reasonably for several reasons. First off, he needs to not be putting too much weight and stress on the sound leg. In too high a percentage of cases, the ACL on the second leg can be torn within anywhere from a few days to a few years post-surgery. A few days would tell me that it either might have been compromised to some degree prior to the surgery on the first leg, so it was weakened. Or, if there is a genetic component to the first ACL tearing, that that component also exists in the second leg, making it vulnerable to damage, particularly now that it is taking more weight and stress. For these reasons, employing all four legs as much as is reasonably possible is a plus.

 

In addition, without using the surgical leg, the muscling will atrophy. Use will help maintain and build muscling, that will strengthen the leg, help support the joint, and eventually allow him to use the leg as an equal partner with the other leg (good for the other leg, good for the dog in general). Also, use of the leg along with exercises will help maintain range of motion, and keep the joints flexible. Regaining his "symmetrical" body muscling will help his whole body, reduce stresses that lead to arthritic changes, and balance out the working of muscles, bones, and joints to the optimum they were designed for.

 

So, I see him using his leg more and more. Swelling is not discernable to me any more. His ROM exercises, when he relaxes (which is helped by the massage, and which relaxation is increasing with the reduction of pain in the area), become easier to do and involve a greater range of motion. I have to be very careful as he is quite excitable when it's time to go outside, and I have to make sure that he stays as calm, quiet, and slow-moving as possible to avoid slipping, falling, or stressing himself while yet getting a gentle bit of exercise and enjoyment out of life.

 

The incision still looks good. The staples are scheduled to come out tomorrow but, if they feel it needs a bit more healing time, I'll just have to take him back next week for that. The incision looks a little rough in spots, as the scabbing is drying and crumbling/peeling off in a few spots, but healthy, pink tissue is showing underneath.

 

There are many, many things that *can* go wrong with this sort of surgery, particularly in the post-op phase. Following a good protocol that is outlined by the surgeon and the therapist should minimize the occurance of set-backs and bumps in the road. We have been very blessed with a so-far uneventful recovery.

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Here is a side view of the leg - I think there's quite a better appearance to it than the similar photo from a week ago, just after I brought him home from the hospital. I can certainly feel that the muscling on this side is much less than the muscling on the other side, but that should improve with time, exercise, and therapy.

 

016.jpg

 

This is a frontal view of the incision. The pink/red areas rather stand out and look angry, but those are just where the scabbing is chipping off and the healing tissue beneath is exposed. Fortunately, we have experienced no oozing or seepage, or other indication of infection or problems with the incision healing. They put in plenty of staples!

 

017.jpg

 

Here is the inside of the thigh. All that brilliantly-colored bruising that was so evident a week ago is now completely gone. And the redness is gone from his lower leg so, rather than "rug burn", I think it was where the bruising fluids had migrated down the leg. He never experienced anything but a very tiny amount of swelling or fluid buildup down by the inside of his hock, from the draining of fluids there.

 

019.jpg

 

Fortunately, no one has taken photos of my contortions trying to take pictures like this. I am on one knee, holding Celt's tail with one hand and the camera under his belly with the other, and trying to see the viewfinder screen to make sure I'm getting a photo of what I want recorded. And trying to get my finger on the button to take the photo. It is harder than it sounds, and I apologize for the poor focus on some of the shots. I got a lot of photos of Celt's belly hair!

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Thanks for journaling on Celt's progress, Sue. You're doing a great service. I've been following since you made the decision and it sounds like things are going as well as they could be. Best wishes for continued success with Celt's rehab!

Thanks, Donna!

 

I'm recording this both for my own use and reference, but also putting it here so that it might be helpful for someone who is facing a similar situation, that it might help them avoid some of my mistakes, reassure them that they can deal with it with the proper medical help, and help prepare them for what lies ahead in the whole process.

 

And, maybe most importantly of all, it's a chance for others who have experienced similar issues/surgeries, to share their experience, what worked (and didn't) for them, and out things turned out so that these valuable lessons can be available to the next person who runs into this (or a similar issue) for their support and information.

 

One thing I have certainly learned, here and through Orthodogs, is that not-one-size-fits-all. Not all injuries are the same; not all surgeons recommend the same procedures/recovery/rehab; not all dogs respond the same way to injury, surgery, and recovery/rehab; and certainly not all owners respond the same to all the above concerns. Education is our most powerful weapon in dealing with issues like these, I believe.

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June 27 2012 - 8 days post-op

 

I'm feeling a bit concerned about tomorrow's visit with Celt's ortho surgeon, and also very glad that we didn't choose to wait until next week. There's an occasional (when we do ROM during his potty walks in the yard) tiny bit of seepage from the part of the incision that goes right over where the joint flexes. Clear, miniscule, dries to pale gold (like serum on a scrape), no swelling, no redness. I think it's just part of the process as the scabbing is loosening and coming off here and there, showing pink, healing tissue below.

 

And I didn't like the way he was walking tonight. While his left leg looks good and normal, he's still toeing in a bit on the right, and doing this little twisty-thing with his joint as he steps forward on the leg. Maybe it's normal, maybe I'm being paranoid, but I'll be glad to get the vet's opinion (I'd be even happier to have the therapist's opinion). I hope I've not been overdoing the ROM. I've been careful and letting Celt guide me, doing a bit more in scope when he's relaxing and tolerating it well, and reducing it when he's not. And maybe it has a little to do with his no longer being on the Demerol. His last Rimadyl is tomorrow morning.

 

I tried to have Ed walk him away and towards me so I could see from a better vantage point than attached to him with a three-foot leash, but he just wanted back with me so much that he was trying to bounce, pulling, and wiggling all over the place. No way could I see how straight he might be walking with all that going on, and it was too much for him to be doing anyway. Maybe I can get Ed to video him when I walk him in the morning.

 

Things have been going really, really well (I thought) and maybe I've just been pushing things or maybe I'm just over-reacting. Either way, I'm eager for the appointment tomorrow.

 

Meanwhile, the boy is happy for any and all attention; absolutely loves his outdoor time, massage, petting, and treats (and handles the ROM well, even relaxing quite a bit sometimes so we can get a wider and deeper movement); and would just like to be off the lead and able to bounce and run. Sorry, Celt, but not yet!

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Sue Foster has some minor seepage with both surgeries. Just like in humans wounds do seep some. The sutured area does still look a little too red in the photo but overall it looks good to me.

 

I am sure the vet will be impressed with how well you are doing with Celt and with Celt himself.

 

One exercise I did that was very simple for getting Foster to put more weight on the leg while standing was slowly made her shift her weight side to side in the backend by just shifting her body weight. I know after my knee surgeries it just felt weird to use the leg and to trust it.

 

The weird walk you mention was actual normal for Foster for the first couple weeks with the first surgery. She had a ton of atrophy so the muscles weren't able to control the leg movements as well. The other knee TPLO we started PT type stuff from day 3 including laser.

 

Again, Foster was weird in she was putting a ton of weight on her surgical legs the day after surgery which was also bad since she had a seroma or whatever it is called from overuse.

 

You are doing a great job with this journal. It will help others down the road.

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Thanks, Kim, your comments and advice have been most helpful! The red spots are where the scabs have dropped off and my camera does tend to over-emphasize redness, I think (I remember that when Molly had her leg wound, that things would sometimes look much better "live" than in a photo - maybe it's the flash). And they are much less colorful today, fading to a pink/flesh color.

 

June 28 2012 - 9 days post-op

 

No seepage this morning before going outside (and I didn't expect it) and not really any crustiness from any dried seepage after last night's exercise. So, virtually no seepage overnight. And I didn't find any this morning after his walk in the yard (we stopped to pull some weeds and he enjoyed a nice lie-down in the cool, damp grass) and then his ROM in the pen in the house.

 

What I'm finding fascinating (here and on FB and reading Orthodogs) is that there are many different approaches to the kind of surgery done (everything from trad or modified-trad for bigger or active dogs to TPLO for smaller dogs, depending on the dog, its lifestyle, the surgeon, the owner's input); many, many different approaches to the recovery period and rehab therapy (everything from almost total rest to fairly challenging, although carefully administered, exercises; a wide variety of "expectations" both with regards to healing and progress (anything from "some seepage is normal" to "call us if there is *any* seepage, it's not a good sign"); and a lot of difference just in how the dog comes along (regardless of other protocols) by his/herself after surgery (dogs that are practically fully weight-bearing the day after surgery to dogs that are still working on soundness weeks or even months later).

 

There is simply not one single approach or one-size-fits-all or a simple answer to "what do we do for ___" and for how long. A person could get very anxious reading multiple sources because while there is some commonality in many sources, there is also such a wide range of divergence as to make a person wonder if they are doing what's right and even if they can know what is the right thing to do.

 

I find it very helpful to read different viewpoints and advice, work it out in my head, evaluate what I am seeing in my dog with what I am doing, consider if something else might be useful, and try to be educated without being confused.

 

I do put my surgeon's advice first - he has a very good track record of success, he is the one who did the surgery, and he is to whom I would turn with problems should they crop up and not be a matter for the therapist. I have faith in him. I will also put the therapist's program into practice once she sees Celt and evaluates him, and draws up a plan of action. I think she is a good choice. And, so far, she has been on board with the surgeon's recommends. And, at the same time, I am trying to be very observant of Celt and "tweak" what I am supposed to be doing with what I see working or not working (providing positive or negative results) with him as an individual. And praying like crazy that I'm always doing the right thing!

 

The appointment for removing the staples is later this afternoon. If the vet feels they need to stay in a bit longer, then I will schedule another appointment for next week, even though we will have to see another vet. I have no worries about the capability of anyone that we would see in this practice for this reason.

 

The normal time frame is 10 to 14 days post-surgery, but this was the only appointment I could get with the surgeon who did the work, and I wanted to have him see Celt if possible, and I also have a few questions for him.

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On a lighter note, Celt spent the first several nights in his pen. This avoided any issues with other dogs, the non-carpeted floor and potential slipping/falling, and my being such a light sleeper that I might not get much rest at all.

 

He then spent a night successfully with us, wearing the Bite-Not collar (last Friday, I think) and we all slept well in our respective beds. When we tried him sleeping with us the next night with the cone, he just wouldn't settle down on his bed and, since I could not risk him slipping on the floor during the night or getting involved with Dan (who has been excellent about all this), it was back to the pen. He seems more comfortable with the cone, drinks more easily, and seems to get less heated with it so I opted for cone-and-pen at night instead of Bite-Not-and-bedroom.

 

I decided last night that he was not happy being "shut out" of the bedroom and, as long as the nights are cool enough, I'd just use the Bite-Not and let him sleep with us. Well, Miss Megan had spent a few nights on Celt's bed in its coveted location on Ed's side of the bed - so I awoke this morning to find Celt relegated to Megan's bed by the bedroom door, and Megan enthroned in Celt's bed by Ed. We'll have to work on this.

 

Part of the reason that Dan's bed is where it is (diagonally across the room from Celt's) is so that Celt and Dan don't see each other, and Celt won't get paranoid about Dan - "He's looking at me, Mom!" even when he's not. "Well, he *could* look at me, Mom!"

 

With Celt sleeping on Megan's bed, he and Dan are directly opposite each other, so we are going to have to place Celt in his bed and make sure Megan doesn't usurp it. Meanwhile, bless Dan's little heart, when we all got up and he naturally was standing not far from Celt and facing his direction, he just turned his head away to remove the pressure from Celt.

 

We are being very careful to avoid any interactions between Celt and Dan while Celt is at a severe disadvantage, could easily be injured or injure his leg, or Dan could take advantage to make a play for alpha status. Dan, so far, has been very good at avoiding potential problems, like he was in the bedroom this morning.

 

Dan was supposed to be in the bedroom when I brought Celt back in from his potty trip (we always leave the two either in the bedroom or in their crates to avoid interactions of any sort right now, for fun or otherwise) but, instead, Ed had let them out and Dan was in the mudroom right by the door.

 

I brought Celt in, not knowing Dan was right there and again, bless Dan's heart, he didn't move (he really wanted out because he had to go potty himself) but turned his head away to let Celt pass without any confrontation. Dan may drive me batty sometimes but he does have some great temperment qualities, too. Thanks, Dan!

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June 28 2012 - 9 days post-op and first surgeon follow-up

 

There is some very good news - the staples came out; the very minor, clear seepage (that dried to a golden but still clear crust) was nothing to worry about; and the surgeon said that Celt is at just the stage he likes to see and expects at this point post-surgery.

 

He liked that Celt is using his leg for walking and, since Celt uses it best without the use of the sling, he told me to dispense with the sling unless I feel it is needed (like on a slippery surface or negotiating steps). He also felt that Celt's somewhat odd gait at this time was perfectly normal (toeing in a bit on that leg, and giving a little twist/hitch to it) and was due to needing the muscles to be strengthened and returned to their former, fit state. And that would come slowly, with time and exercise and rehab.

 

He was pleased that our first rehab appointment is a week from Saturday. All in all, he was very pleased with Celt's progress.

 

But there is something to be aware of - in his experience, about 70% of dogs with this injury will go on to blow the other knee, sooner or later. That was a shock to me - from what I have read, I understood about 20% of dogs experienced the other ACL failing. I thought that if I did everything I was told to do, invested in the rehab and followed those instructions carefully, and worked to bring him back with professional help and being diligent, that the likelihood of the other leg experiencing the same problem would be minimal.

 

I asked him to look again at Celt's x-rays with me and measure the tibial plateau angle, to give us an idea just how much of a candidate Celt was for another tear. He measured the angle at 28-29 degrees, which is considered fairly steep. He said that an angle of 32-33 degrees would almost surely result in at least some tearing with wear and activity, being very steep. This is on the leg that blew, but there's nothing to indicate that the other leg would not be similar in structure since there were no apparent abnormalities, but it would take an x-ray to check the angle on the other leg - which I may ask to have done at his 8-week check-up when this leg will be re-x-rayed to check for bone healing.

 

So, I need to be prepared and be observant to keep my eyes open for any signs of pain, odd gait, toe-touching, leg-holding, etc., in the left leg as we continue to work at rehabbing the right leg. So, while the check-up was satisfyingly good, I am feeling rather down. I'm worried about Celt hurting his other leg; I'm concerned about us all going through all this again (and we've only just started the recovery phase; and I have to say that this will have cost quite a bit of money, and it's rather daunting to consider another, similar expense in the future.

 

So, that's where we are tonight - some very good news and some worrisome considerations. The surgeon felt that Celt should return to full activity, stockwork and playtime, after sixteen weeks post-op, following about four months of rehab, depending on how it goes, but not before then. Sorry, Celt, you are not going to be the dog doing the morning calf chores this fall...but you should be back in service just about the time the calves leave. I won't tell Dan quite yet.

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That is come good news.

 

You will drive yourself crazy worrying about the other knee. I won't say don't worry about it but don't stress over it. There is nothing you can really do to stop it. Hopefully he will start using the surgical leg more and more and take some pressure off the non-surgical leg.

 

Foster blew her other knee 2 years after the 1st one. We knew it was coming and put money away. You may want to think about doing that going forward.

 

Again, great news about Celt doing so well.

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Thanks, Kim, I knew you had experienced this first-hand.

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Truthfully, we always expected her to blow her left knee first, not the right knee. She had hurt that left knee a couple times. She was on crate rest off and on for a few months. We were surprised it took so long for her to blow that knee out after blowng the right.

 

And this is with her playing flyball 6 months after the first surgery and it still took 2 years. After the left knee she was playing again in 6 months and played for another 3 years before being retired at 12 yrs old.

 

I tell everyone Rehab is the key.

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The more I hear about it, the more I do believe (as you say) that the key is rehab/therapy. It doesn't matter how good the surgery is if the follow-up is not appropriate, well-designed, and well-executed.

 

I am very much looking forward to our first rehab session a week from tomorrow. Where I think the vet's office gives you useful and helpful information, I think it is really bare-bones (and maybe they just don't expect people to either be willing to do much or capable of doing much) but my impression of the therapist is that she really puts the time into evaluating the dog, working with the dog, and teaching you how to work with the dog.

 

What I learned from the vet office was minimal and basic, and I'm really anticipating getting a challenging plan from the therapist but also learning the skills I need to really help him in an intelligent and successful manner. That is, after all, the point of therapy, is it not?

 

Meanwhile, it's very hot today but he enjoyed his morning potty walk and some cuddle time on the lawn (it was that warm and dry before 6 am that I could sit on the grass with him for some massage and a bit of ROM since I would be at work and not able to walk him during the day). And he didn't want back in the house any too quickly from his afternoon stroll but enjoyed some grazing and sniffing. And, with Ed to monitor the other dogs on the trip out (he vanished while we were out there), for the first time, we had all three out at once.

 

Dan was so pre-occupied with watching the Chuck-It in its place on the porch that he was no issue for Celt, and he was very polite coming in, staying away from Celt. However, just having Dan in the mud room made Celt a little anxious about wanting to rush to his pen (he did not because I anticipated it and prevented anything but a calm and slow walk), that I don't want to do that again, even if I simply have to continue taking the three out in two separate shifts as I have been doing.

 

Something I have noticed is that for the last several days, Celt has had an itchy chin. I thought a few days ago that he might have gotten stung by something small and buzzy out in the yard - it appeared that he had a small puffy area under his chin and it was itchy, so that he would often do some real serious chin-rubs after his massage and ROM.

 

But then I noticed occasionally (including after work today) that when I took him out (and the Bite-Not or e-collar are taken off for trips out only), he would really get to scratching his collar area (he can even do this with the bad leg, and it seems to be a great ROM exercise :lol: ). I'm wondering if the collar is irritating him, maybe keeping his chin damp.

 

So, while the vet said to keep using a collar for another day (until tomorrow), I took a close look at his incision and decided to try leaving it off - so far, this evening, he has not licked the incision area. All the scabs are gone at this point so I think there is nothing there to itch or pull on the skin. If he leaves it alone, we'll leave the collar off. If he starts to fuss at it, the collar will have to go back on.

 

He's got a very happy, cheery attitude - particularly when he gets to go outside or gets personal attention. Other than that, he is bored but I'm thinking of a few things I might do with him if he needs some mental time. At his age, fortunately, he's a pretty laid-back guy.

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Whoops, must have hit "post" twice!

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Back to June 28 2012 - 9 days post-op

 

Here are two photos, showing Celt's incision just before we left for Pittsburgh -

 

012-1.jpg

 

And just after getting back from Pittsburgh, after the staples were removed and the tech had gently removed any crusty material (my camera always seems to accentuate the red and makes this look more livid and angry than it is - it's not gaping like it appears to be) -

 

014.jpg

 

And a very short video taken just before we left yesterday - what I have been wanting to do is get video every few days of me walking Celt to show his progress but, with Ed making hay most days this week, I just haven't gotten it done. So I dropped the leash and started the camera, and let him walk. Too bad he took that to move a bit quickly (and you can just see him hitching that leg up as he's moving too fast) but then walked quietly closer to me (and you can see him using that leg), and took a sit-down (he sits down, putting the weight on the good side but he can just as easily sit down or lie down on the bad leg side, too).

 

th_013.jpg

 

Let's see if this link works and, if it does, you can see a happy, healing dog! If you double-click on the photo, you may be taken to the video. But, since my Photobucket is private, that might not work. Someone, please let me know or tell me how to do it right!

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Storms took out the power over much of a wide-spread area from Ohio to Washington DC. I'm on a computer in town momentarily so just wanted to say that Celt is doing well. With his cone off on Friday evening (he was getting itchy under the collar of the cone), he gave his leg a very thorough washing-up, and has left it since then.

 

Incision progressing well - less color, smoothing out a bit, looking better each day. He's walking on his yard walks better and better each day. Where he was only walking on all four when walking very slow, he is now walking on all four at very slow and moderately slow paces, and occasionally at a very slow trot. He rarely holds that leg up, just sometimes if he gets excited and is about to try to bounce a bit (which I prevent asap).

 

He's got a good attitude, bright and cheery. We go out and he does his potty business, and then I give him a stroll about the yard so he can sniff and graze. Sometimes we stop at the asparagus bed, which I am in the process of weeding, and he lies in the grass while I weed.

 

He's bored, wanting more fun and to play, but being very patient (most of the time!). He's doing well, and I'm looking forward to our first therapy session this coming Saturday.

 

The storm was full of lightning and thunder and wind. When the rain came, it came down sideways. The rain gauge said we got 2", which we certainly needed. We were fortunate in that, other than losing power and not knowing when it will be restored (they say up to a week), we have experienced no damage and our neighborhood seems to have been spared damage, also.

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July 2 2012 - 13 days post-op

 

Since our power is still not back on, and since I apparently still don't have DSL at home, I'm just posting a short report on Celt's progress as of this morning.

 

I have a photo that shows that the incision is healing well. Red areas are fading rapidly, there has been absolutely no gaping ever, and there has been no seepage since last week, when just very minor signs were seen after activity (potty walks/ROM).

 

As for his gait, it was just a few days ago when anything faster than a very slow walk resulted in him hitching up his surgery leg and going on just the three sound legs. Within the last day or two, he has not only been using all four at what you might call a "working" walk (a more purposeful walk than just a slow stroll) and even now at a slow trot (he breaks into a slow trot occasionally but I try to avoid that and say his name and tell him to "walk").

 

So, he is making progress that is often visible on almost a daily basis. I realize that he is doing very well, and many dogs might not be progressing quite as well and yet are still making good progress for their condition.

 

Will post again when I have access to the internet. Thank you to all who have been wishing us well!

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July 7 2012 - 18 days post-op and first physical therapy/rehab session

 

I think my brain is about to pop - I thought this PT thing was going to be easy, simple, just working with *the leg*. No way, it's a "whole dog" approach and I am beginning to understand why it's a matter of training and hands-on experience that makes a therapist's input so valuable.

 

The last few days, Celt's walks have been extended just a bit - instead of five to ten minute easy strolls around the yard, I have also been walking him slowly and gently up the road by our house, which goes up a hill. Now, if you are pushing it, it's a tiring, steep hill. But, if you are strolling, it's a nice gentle uphill walk. And then back down again. It's maybe a tenth of a mile so when you add the yard walking to the round trip, maybe 1/4 mile at a slow and gentle pace. He's been enjoying it, early on and late in the day, when it's not so blooming hot. Lots of stops to sniff along the way, do his business, feel the breeze, enjoy being an "only dog" out for a stroll with me. And it's a way to gently get some exercise for all four legs (all six, if you count mine, which need it more than any of his).

 

We drove up for his first session today, and spent two full hours of observation, hands-on, cold laser, ROM exercises, a three-legged exercise, walking over cavaletti, and underwater treadmill. Celt's tired, and so am I! I think we both enjoyed the therapist, Shari, very much and Celt was a good boy, pretty trusting (as is his nature) and usually relaxing into the exercises.

 

Once Shari, Celt, and I had made introductions, we went back into her spacious therapy room. It's outfitted with a nice mattress for the ROM exercises, a large underwater treadmill (I'll explain the size later), a hydrotherapy tub (I wondered if I could spend some time in there myself), and various items of physical therapy equipment (like the cold laser, cavaletti, and so on).

 

Shari asked me just a few background questions and spent the first little while just watching Celt as he roamed around exploring, getting an idea of how he was using his leg without any interference from us. She actually expressed her pleasure at how he was doing, how well he was beginning to use it, how well he was moving about, and his cheerful attitude. She liked how I was walking him and felt that was very appropriate for his current condition.

 

Once that was done, Shari got down to working with Celt. She was more than happy for me to take photos so that I could refer to them when doing our "homework" and so that I could share them here - she thought that was a great idea. However, I want to point out that these photos are to illustrate what *we* are doing with this one dog, and not to be a guide for someone else to work with their dog. Any other person whose dog is undergoing treatment should be working with their dog's medical care professionals to devise a plan of treatment and rehab therapy. These are to illustrate Celt's and my experience, and to share what a course of therapy might involve.

 

After a good, hands-on examination of Celt, Shari had him lie down on the mattress on the floor and proceeded to use the cold laser and some massage/manipulation to work with "the whole dog". So, to my surprise, she didn't jump right into evaluating and working with his right ("bad") leg. She started with his spine and then his whole body, getting a feel for his muscling, build, and tender spots. And she did find a bit of tenderness along his back, in the loin area, which was not a surprise as a dog who is compensating for a sore or injured leg is going to be using different muscles and working them somewhat asymmetrically, causing some stress and strain and unevenness.

 

A measurement of his thighs with a special measuring tape indicated that his right leg has a circumference about 4 centimeters shorter than the left leg, showing that there has been muscle loss (atrophy) due to reduced use of that leg that had the surgery (and that he had been favoring to some degree, even a small amount, for several months prior to the surgery).

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Then Shari proceeded to administer a series of range-of-motion exercises (ROM), and show me how to do these at home. Twice a day, about six repetitions each, on both sides of his body – because, if you only work with the injured leg, you will be neglecting to strengthen and care for the other three legs, which are being stressed by compensating for the one weakened leg.

 

For the hind legs, there are three ROM exercises. Shari demonstrates how she uses her hands to not only perform the exercise but also to support the joints as she manipulates the leg. Each exercise should be done very slowly, allowing the dog to relax into the exercise, and only to the point that the dog indicates is beneficial (I could see in Celt’s case that if she approached the limit to which the leg should be moving because his muscles were not able to stretch or flex more, he would begin to tremble ever so slightly and, at that point, I should back off just a bit so as to not overdo the exercise).

 

The first hind leg ROM exercise is a flexing up toward the body, making sure to support both the inside of the stifle joint and thigh, and the lower leg (below the hock). A good, relaxed flex will result in the leg going all the way up. This photo was the first I took, and he was flexing more tightly with succeeding repetitions, so this level of flex was not quite as far along as was our goal today. Each rep includes a flex up to the body and then a gentle stretch straight out and down (which would be towards the floor if he was standing).

 

1-ROMlegflexion.jpg

 

The second hind leg ROM exercise was a stretching forward. Shari’s left hand is stabilizing the hip joint and upper leg while her right hand is supporting the hock joint and easing the leg forward into the stretch. These two photos show the stretch partly done and at its full extent.

 

5-ROMlegstretchforwardpartway.jpg

 

6-ROMlegstretchforwardextended.jpg

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The third hind leg ROM exercise is a hamstring stretch. Shari takes the leg, stabilizing the rump with her left hand and supporting the stifle with her right hand. The first photo is to show off the leg position, while the second photo shows how she actually places her hands and arms to do the exercise (but which makes for a less-illustrative photo). This is the exercise where I could see Celt’s leg tremble as his leg approached the limit to which it should be extended. When that happened, she gently eased it forward just enough to stop the trembling. His muscles are still quite weak and do not have the natural range of motion they would have when he was healthy and well-exercised.

 

7-ROMhamstringstretchpartway.jpg

 

8-ROMhamstringstretchextended.jpg

 

Then, Shari administered some cold laser therapy to Celt’s front leg joints, and proceeded to do some ROM exercises there, just a simple set of forward and then backward stretches. Using her one hand to stabilize the elbow, she used the other to both support the wrist and maneuver the leg into a long, forward stretch, and then a long, rearward stretch.

 

10-coldlasertherapy.jpg

 

12-ROMfrontlegforwardextension.jpg

 

14-Frontlegbackwardextension.jpg

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Between all the groups of exercises, Celt was given the chance to get up, walk around, get some treats from me, and be sociable, so he could relax and feel comfortable and so he could rest his brain a bit. One thing that Shari noted was that Celt was very “flushed” – his belly, his incision, his lips, even his gums were quite pink. That’s an indication that no matter how relaxed he seemed on the outside, inside he was stressed and anxious. I had noticed that, too, but thought it might have to do with his mild, seasonal allergies, and I will also begin to give him his antihistamine tonight if the redness remains (which we don’t expect).

 

The next exercise is what Shari calls the “three-legged dog”. She stands over the dog’s hind end, with her foot touching his hind foot that will remain on the floor, and her leg there to support his leg, and she does the ROM flexing exercise to his other leg. When she is flexing his left (good) leg, she only brings it up partway since his right (bad) leg is bearing his weight. When she is flexing the right (bad) leg, she brings it all the way up for full flexion (and because his left or good leg is on the floor). Her other arm is always supporting him under his waist so that he is not putting all his weight on the leg on the floor and, between that arm and her foot/leg alongside his, he is being stabilized and steadied.

 

16-three-leggedexercise.jpg

 

17-three-leggedexercise.jpg

 

The next exercise (I was getting pretty tired at this point, and so was Celt – he and Shari were doing all the work and I was trying to take it all in so I could do my part working with him at home) was to walk over a series of three cavaletti set at about 6-8” high. This did not go so well as Celt, who has had a little bit of agility for fun, was quite prepared to just jump them all. We had to work together, myself holding the leash and slowing Celt down, and Shari guiding his hind end to get him to “step over” and not hop over.

 

The first time through, we got nothing but hops. I was not going slow enough. The second time through, we got mostly hops. The third time through, I was able to keep him going slowly enough so that she could lift his right (bad) leg over the bar and place it, and then he would have to step over with his left (good) leg, relying on his right leg to hold his weight. She sent me home with one set of cones and bar, and I know I will need Ed’s help to accomplish this one exercise.

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