An ACL tear and TPLO journal

[Sue R]

Finally, it was time for the treadmill. Shari’s facility has a very large treadmill and that’s not just to accommodate large dogs. She gets in the treadmill with the dog to make this another hands-on exercise. First, she let Celt take a look around inside the treadmill. He said, “Thanks, but no thanks, I’m not interested. I’d rather get out with my Mom.” Once he’d had a good look around, she turned the water on and the warm water flooded the apparatus so that there was enough to provide resistance when he walked while it also supported some of his weight and provided support.

 

Shari gave me the controls and had me stand at the front, so Celt would naturally orient himself in that direction and not try to move in any other direction. On her instruction, I would turn the treadmill on and off – she did three sessions (with relaxing breaks in between) of two minutes at 0.8 miles per hour. Celt has never been on a treadmill before, is not a fan of water unless it’s ball play time or he’s really hot, and was not thrilled – but Shari said his reactions were normal and he did quite well.

 

 

Shari again supported his weight a bit but also used her support to encourage him to be “even” – in other words, to not lean in one direction or the other but to use all legs as evenly and smoothly as possible. After the first two sessions, she said I could come around to the side and video but I hit the wrong button and so did not get the footage I had hoped. What the side view showed more clearly than the front view is that while he was using both hind legs, he was taking longer and stronger strides with his left leg than his right leg. It was much easier to see on the treadmill than it was to see when he was just walking around on the floor. Next week, I hope to get some video of that because it’s very obvious from the side.

 

Here is a short video from the front, in which it is not as easy to see the unevenness in his stride as it would be in a video from the side. But you can see (in the earlier seconds of the video) that he is not extending his right leg as far forward or back as his left leg. Also, while his natural leg position is to slightly toe-out, his right leg moves straight on. Earlier on in his recovery, he was actually toeing in (and his stifle joint was twisting inward ever so slightly), so there is improvement seen there already, getting back to a more natural movement for his structure.

 

You can see Shari supporting him. She has a mirror to her right, angled just so that she can see his legs moving beneath him, giving her an excellent view of what he is doing with all four legs.

 

 

Our next appointment is in one week. While this first getting-to-know-you appointment ran for two hours, a normal appointment should run about an hour. An average dog takes about three months of weekly appointments to be ready to resume life’s activities, and so we shall see how well Celt progresses.

 

One additional comment is that Shari found what I had thought was just a bit of scab on the very top of Celt’s incision, which she thinks may be an internal stitch working its way up and out. I am to keep an eye on that. It is a source of potential infection but, as of now, there are no indications of any infection or seepage. Just another something for me to observe (and probably worry about).

 

Our first week of at-home exercises are (twice a day) -

 

10 minutes of walking (up the road and back down again, which is a significant slope)

 

ROM exercises on all four legs, six reps, counting to six

 

three-legged dog, both hind legs, six reps, counting to six

 

6 to 8 passes over the cavaletti, set at 6"

[Sue R]

The exercises look much easier when someone else (someone with experience, too) is doing them but they weren't hard to do and they, plus a nice slow walk, are done for the day.

 

Meanwhile, he does indeed have an inside stitch coming to the surface at the top of the incision. I can see it clearly, a blue plastic material. I'll give the vet a call on Monday as there appears to be no problem with it right now.

[Gideon's girl]

I'm glad Celt is doing so well!

[2 Devils]

Sue - that first picture shows the one exercise I was trying to explain to make sure the hock doesn't lose flexibility. At least that is how I started it.

 

Those exercises look so familiar. I wish I would have taken pics. Great idea.

 

I am glad all is going as expected (slightly better even).

[Sue R]

July 8 2012 - 19 days post-op and second day of at-home PT

 

I think this is one of those one-step-forward, one-step-back days! Shari had warned me that Celt should be very tired after his session yesterday; that he, like all dogs in this situation, would have a short attention span and so PT sessions should be short; and that he would probably have some discomfort after that long, learning session.

 

Normally, she would have recommended a dose of Tramadol for him that evening but we have an odd situation - the vet office that Shari works out of is not my regular vet office, and therefore he is not a patient of Shari's vet. So, she would not dispense a dose of Tramadol (Shari explained that it's a controlled substance and so the rules must be followed strictly) without a script from Celt's regular vet (unless, of course, I made an appointment with her, had the exam, yada-yada). And it would be pretty tacky of me to contact my vet office, with their own rehab facility that I have chosen to not use in this case, and ask them to send a script up to this vet. Or even to stop at my vet's on the way home to see if I could get a dose. And I had nothing at home, no Rimadyl or anything else to dull any potential achy after-effects.

 

But, since Shari felt that Celt, showing the progress and attitude he has shown, would do okay without the Tramadol, we just did not even pursue that option. I did the exercises last evening and was very pleased - Celt was quite relaxed and cooperative. Because he was relaxed, I was able to get good flexion and extension on all lying-down exercises, which was a nice surprise.

 

We did have a bit more difficulty with the three-legged exercise. I think that's just something that I will have to learn how to do more effectively. And then there was the cavaletti. I got Ed to take the leash so I could handle the hind legs to guide Celt into stepping and not hopping over the bar. I think this was an example of the Keystone Kops meet The Three Stooges.

 

It took a few tries to get Ed to go s.l.o.w. e.n.o.u.g.h. that Celt would walk. We had a few whole body jumps and a few walk-on-the-front-and-hop-with-the-rear, before we managed to get half-a-dozen step-overs, with me having to pick up Celt's bad leg and step it over, and then make sure he stepped his good leg over. I was dripping wet by the time we were done.

 

This morning, I felt he looked a bit more stiff than usual, maybe just a little sore from all the activity yesterday. As planned, I took him (and the other dogs this time as they have been so good with him) for a walk up the road and back again, to get his little bit of exercise and to get his body "warmed up" in preparation for the PT exercises.

 

Because we would be heading off to church and I didn't want to work up a sweat, instead of doing the exercises out on the lawn, I brought him inside to do them, and was very disappointed as he just would not relax for me, and I found it hard to get a good range of motion on any of his legs, compared to yesterday. He seemed to be fighting me at times, resisting letting me ease his legs into the flexion and extensions.

 

With the hot weather we have had, it would be nice to have the option of doing this indoors as well as out, so I shall try doing it somewhere else in the house - I did try it in his pen this morning. Maybe he felt too confined or maybe he just didn't want to be in the pen (we did the surgeon-recommended exercises usually on the lawn but sometimes in the pen, equally well). And he may just also be getting tired of pen time.

 

I did set up the cavaletti in the family room and try doing that by myself. I had a problem with him popping over when I had him moving toward the front wall but got him stepping over nicely when we went in the other direction. I think a few more sessions of that, and perhaps we can be pretty consistent in doing it correctly. It's handy to not have to have help to do this so I need to learn how to accomplish it alone because I can't always ask for help - and, because anytime I ask Ed's help in working with Celt, it seems to be very distracting for Celt. He is always wanting to get silly or to watch me, which is counterproductive if I am trying to work with his rear end while Ed leads him. We are not seeking the doggie version of Twister!

 

We'll see how it goes tonight.

 

Meanwhile, Dan continues to be very respectful of Celt, lets Celt come over and sniff him (Celt is that way with both Dan and Megan, as if he is reacquainting himself with them), stays out of the way and lets Celt go first, and is in all ways being very good about this whole thing.

[Sue R]

Sue - that first picture shows the one exercise I was trying to explain to make sure the hock doesn't lose flexibility. At least that is how I started it.

 

Those exercises look so familiar. I wish I would have taken pics. Great idea.

 

I am glad all is going as expected (slightly better even).

Thanks, Kim! The first exercise, the flexion, is the same as what the surgeon was having me do (along with the bicycle exercise) so we were doing it all along. However, I always found it harder to get the flexion in the hock joint than in the stifle joint, so I had to work on that.

 

One other thing Shari pointed out was that if you compared the pads on Celt's hind feet, you could readily see where he was not using the right leg at all as much as the left leg, and was actually supporting what little weight on it as he did with the two middle front toes, not the outside toes or pad. Toe-touching (or not placing the foot flat and square on the ground) is a symptom of an ACL tear (and, I am sure, other injuries of the leg). You can compare them in this photo, seeing only a little wear-and-tear on the fronts of the two middle toes on his right foot, but a normal appearance on all pads of the left foot. Knowing what to look for here, gives me another indicator of the reduced use of that leg even when he looks like he's using it pretty normally when watching with an uneducated eye.

 

Puffiness in the pads is also obvious - that's at least partly because he is not using the foot for normal impact and pushing off. Not using it reduces the blood flow back through the veins as normal use stimulates good blood flow.

 

[Maralynn]

I'm enjoying this journal, Sue. The information you're presenting is top notch. Sorry that you had to go through this with Celt, but I'm glad that his road to recovery is going smoothly!

 

I had a question about the cavaletti exercises. Is there a reason you need to start with the poles 6-8 inches in the air? I know when people use them for conditioning a dog they often start with the bars on the ground then gradually move them up as the dog gets used to stepping over them.

[Sue R]

Thank you for the comments!

 

I'll have to ask Shari about the pole height. I'm just doing what she did and told me to do. Perhaps she evaluated Celt's use of his leg and felt that for his size and progress level, that was the right height. I will ask this weekend when we go again.

 

Celt has been trained to jump in the past and so going over was not an issue at all - going over *at a walk* was what we had to work on, and he understood that pretty quickly. By the second day of exercises (his third time), he walked in one direction (but hopped in the other). By his fourth time, he was walking both ways, although prone to hop in the one direction if I was not careful to keep the pace slow enough. Now, the fourth day, he steps well in both directions but, again, I do have to set a slow pace or he is likely to hop.

 

Avoiding distractions is important (no dogs, no cat present) and I find he gets bored after the first five or six step-overs.

 

I also find that with all the ROM we are doing plus the walking (still as slow a stroll as I can impose, even though he's raring to go faster), he is showing some indication of discomfort/stiffness in that leg - which I understand is not unusual as we are working it and the ROM exercises are pushing the limits of motion.

 

His attitude is great - he thinks he should be working cattle, chasing balls, and just going as fast as he would like. I am the fun police.

[Tiga's_mom]

So glad you're both doing so well! This makes me wish I had done the same when we were going through it with Tiga.

[2 Devils]

I am only guessing since I don't know Shari but when Foster was doing rehab we used 6-8" flyball jumps. This was to force her into walking over the jump by bending the knee joint and not jumping over it. On the ground may be ok to start with (get used to) but it won' give the desired effect of making them actually use the leg properly. On the ground means they may only life the leg a inch or 2 where higher makes them actually bend the knee more... does that make sense?

[Sue R]

Yes, it certainly does.

 

One thing she pointed out with the first therapy session was that it would be "work" and that I could see Celt doing certain things (or choosing to do certain things) a particular way because it was "easy", like the way he sits with his weight on his good leg and his bad leg sticking out to the side.

 

I can see that even the easy-appearing things that we are doing (the easy walks, the ROM and other exercises) are work and they not only tire him (particularly his leg) but they also hurt a bit, and so he is a bit anxious about the ROM and related exercises.

 

I have many questions for her when we go this Saturday. I just need to write them all down so I don't forget any. She has told me to call at any time but so far, there is nothing that I am particularly worried about as long as I do what she has shown me to do.

[2 Devils]

For the lazy leg when sitting thing - we would do sit exercises against a wall (the bad leg on the side of the wall so foster couldn't let that leg just be lazy when sitting). I would need to use by body some to prevent her from trying to shift herself to give that leg more room. I would also do this exercise while sitting on the floor with Foster between my legs and I would use my legs to force a narrow for her to sit. Yes it was pretty interesting to watch I am sure. Foster's sitting was never her strong suit anyways as she preferred to sit on her butt in a lazy sit so in the long run her legs still stuck out some when she sat but not as bad as before these exercises.

[Sue R]

Great ideas, Kim - thanks for sharing them!

 

Celt has been a lazy sitter, too, unless there is something in front of his nose that looks yummy. Then he can sit "at attention".

[Sue R]

July 14 2012 - 3 1/2 weeks post-surgery and 2nd therapy session

 

The very welcome evaluation by Shari, the therapist, is that Celt is making great progress! He is bearing more weight on his surgical leg (can readily stand on it to scratch his tummy with his other leg, and can scratch his tummy with this leg); his gait is more symmetrical; his paw pads show that his surgical leg is bearing more weight and bearing weight more properly, not just on the toes; his 10 minute, twice-a-day walks are to be expanded to 15 minutes, twice a day; his underwater treadmill was expanded from 2 minutes, three times, to 2 1/4 minutes, three times; his ROM exercises are showing improved range of motion (and will be continued as done this last week); his hamstring (the first muscle bundle to show improvement normally) is showing improvement in size and firmness (and the rest of his thigh is showing improvement, although we did not measure today); his step-over exercise (the bar) is increased from 6" (which he can do easily now) to 8" (which take an effort, and he tries to make it easy by hopping instead of stepping).

 

Shari watched him walk around a bit, just to see how he used his leg "candidly", and a smile was on her face to see how he was doing. She did the cold laser on his back (still a bit of soreness in mid-back, due to his working his body asymmetrically to “favor” his sore leg) and his ROM exercises, where she felt he showed improved range of motion.

 

She did the three-legged dog exercise, which is our hardest one to do, and she showed me that he was doing very well when she does it. She said that it is a hard one for all the dogs to do, and so I did not feel quite so badly about having problems with it. I will have to work more diligently on it. And she pointed out that some of the problems I thought I was having with it were just my thinking they were problems, like him shifting his bad leg during the exercise.

 

He did not do well on the higher cavaletti as he was doing with the lower height but we will work on that. It's more effort and it's outside his "easy" zone and so he will need to work harder to do it right, which means I need to work harder to help him to do it right. I may even need Ed's help at first, one at his head and one to guide his feet, until he gets the hang of it.

 

We were both quite tickled when I showed Shari his paw pads, clear indicators that he is using his leg more to bear weight and also striding with a more natural, more reaching stride. He is bringing his leg more forward before the foot hits the ground and holding it further back before he lifts the foot. You can see the difference between this shot, taken three days ago (four days after his first session), and the photo above that was taken last Saturday. The difference is even more noticeable now. There is more wear and less swelling visible on the bad leg's foot pads.

 

[Sue R]

I'm really bummed that I did not get a good video last week of his underwater treadmill to compare with this week's work - he is striding more smoothly through the water and not getting as tired as quickly. He was so eager to get into the tank that he kept getting distracted, staring at it and wanting to go to it, while we were doing the cavaletti. And, when Shari opened the door to the tank, he walked right up the ramp on his own and then was very relaxed as she came on it and started filling it with water. He also enjoyed sniffing around it as the previous dog was an old friend (Cindy’s Anya, who had just left before us, with a glowing progress report).

 

Shari did not need to support him at all this week, just holding his neck to steady him to walk straight ahead and not turn around. His strides were longer and smoother, and he was not quite so tired, so she could extend each of the three sessions by 15 seconds. It was easy to see that the work was challenging and tiring - he would walk more squarely in the first session or at the beginning of a session, and then he would tend to walk with his feet more centered under his body as he tired (an attempt to center the weight over his feet more and make it easier on his bad leg). That was easy to see when I stood in front of him - seeing his feet staying nicely under his elbows and thighs at first, and moving in towards his center line as he tired. It's amazing how much you can see when someone knowledgeable points it out to you!

 

It was hard to get a good, straight-on side view video. Because of lighting, when I tried it straight from the side, I would get too many reflections in the video, so this slightly-angled video was the best I could do. If you watch, you can see how his bad leg does not track as far forward or back, and that he steps a bit more highly with it (like a little prance).

 

 

Because he was doing so well, Shari did not put as much water in the tank. The water both provides resistance to make the exercise more demanding and make the dog *use* the leg, but also provides to support the dog's weight to whatever degree is provided by the level of the water. This week, she put in several inches less water, still providing resistance but not buoying his body weight in the same way.

 

About Kim’s question concerning a sitting exercise – I asked Shari about this and while she said that is an exercise to be done at some point in time, Celt’s not yet at that stage of progress. She did point out that he is sitting better (more squarely) this week than he was sitting last week, and that that’s all part of his progress. His hind leg is not only not yet strong enough, but the degree of flexion in the hock is not yet there for this exercise.

 

But we do have one new exercise - walking backwards. That sounds much easier than it is. While Bute and Dan have both been dogs that walked backwards with ease in "regular" life, Celt has never been a fan of walking backwards, and so that will take a bit of teaching, and patience on my part.

 

So, the program is to increase the walking time by 50% to two 15 minute walks (not fast, not slow, just a nice working walk) a day; continue the ROM twice a day after the walks (but, instead of my doing each exercise six times, then the next exercise, to alternate for each leg – for instance, flexion, forward, then back, repeat); continue the three-legged exercise; learn to walk backwards; continue the cavaletti but at the 8” height instead of 6” height.

 

Our next appointment is on Thursday evening since a family activity is scheduled for Saturday. I’d rather space them out weekly and would prefer a Saturday to a workday night, but the good news is that I will be going up with my friend whose dog is also getting therapy (for a different issue) and so we will have fun chatting in the car and seeing each other’s dogs in their treatments (which are radically different as they have very different things being treated).

 

The second week's at-home routine is (twice a day) -

 

15-minute walk (mostly on the sloping road, the rest is a very gently-sloping driveway)

 

ROM exercises, all four legs, six reps, counting to eight for each

 

three-legged exercise, both hind legs, six reps, counting to eight

 

walking backwards, about a total of 12'

 

walking the cavaletti about 10 times, 8" high

[Maralynn]

But we do have one new exercise - walking backwards. That sounds much easier than it is. While Bute and Dan have both been dogs that walked backwards with ease in "regular" life, Celt has never been a fan of walking backwards, and so that will take a bit of teaching, and patience on my part.

 

I've found that the teaching phase goes easier if the dog has a target to back up to. I've used things like a upside down feed pan or carpet square. With Kenzi I also used steps. It seems to make the dog aware that he's supposed to be doing something with his back feet, ie, looking for the other surface. In turn this seems to make the idea of backing up click faster.

 

I used a clicker, placed the target directly behind the dog then stood in front of the them and walked into their space slightly to encourage them to take a step back. As soon as the back foot hit the target, I'd mark and reward. Pretty quickly they were "looking" for the target with their back feet which naturally caused them to move backwards. You can set this up next to a wall or between a sofa and a coffee table if you need to help channel the dog more.

[Sue R]

Thanks, Mara! Actually, I tried Celt along a wall at the therapist's, then between the couch and cedar chest in our living room last night, and this morning between a couch and his bar (which is supported by cones at either end). By this morning, with just a hand on his collar and a hand to help guide him as he got started, he did very well. He backed alongside the couch and then for another six feet across the floor with my one hand on his collar and one hand at his side.

 

He's been picking up the concept of how to do these different exercises very quickly. Other than being smart and all that, I think he is just so much enjoying the one-on-one that he's putting his thought into what we are doing together and trying to get it right. Of course, he gets lots of praise when he's doing well.

 

I have never had the coordination to work a clicker...

[Sue R]

July 17 2012 - four weeks (to the day) post-op and ten days of physical therapy

 

Just an update on how Celt is doing at this point in time. He is walking for 15 minutes, twice a day, usually on the road (it's not smooth and I am careful to keep him from the rougher spots as much as possible), including uphill and back down. If his leg wasn't still obviously clipped, to an uneducated eye, I don't think any irregularity of gait would be noticed. Of course, to a person like Shari, there is going to be visible some shortness of stride in the leg that was operated on, no matter how slight.

 

As he builds some muscle and stamina, this will get easier and easier. It still can tire him a bit and the hot weather may make it seem like he is more tired than he really is. I go straight to his ROM exercises right after his walk, so that all his legs are warmed up and limber.

 

We have two steps going up into the house and out again. I used the sling for the first two weeks or so to make sure that Celt did not over-use his good leg here and slip or fall. I have made an effort to make sure he goes up and down these very slowly and, when I do, he uses both legs as he steps. If I am not vigilant enough (and he does get excited going in and out, so it's a hard thing to avoid him hopping), he will hop and even skip the middle step. When that happens, it's "Bad Sue", because it's my job to prevent that.

 

I can see in looking back at the photos I posted, and from what Shari noted in his Saturday PT appointment, that his range of motion is increasing. It is important that I don't get at all tense or anxious about this part of his therapy because, if I do or if I try to rush things at all, he stiffens up and resists me and the exercises are not going to go well or be as beneficial. Today I made a real effort to stroke and massage him a bit beforehand and get him "mellow", and I think it paid off in a very good session.

 

He can flex more deeply and stretch to a greater extent but I can also tell which exercises he is more comfortable with and which ones not. He is very relaxed for the foreleg stretches. He is quite relaxed for the hind leg flexes, but finds the foreward and (especially) the back stretches to be less enjoyable. So I have to work to make sure they are done well and to the extent they should be done, without pushing him too hard. It's not always easy!

 

He's doing better on his three-legged dog exercise as I am understanding it better and not worrying about things that I shouldn't be worrying about in doing it. And, as the strength in his leg increases, it becomes much easier to do.

 

He's gotten the hang of the back-up exercise, although his strides are still very short and he doesn't have much of an attention span for doing this.

 

He is easily negotiating the 8" high cavaletti. That's our last (and "reward") exercise as we both find it relaxing and rewarding. And, in the last few days, he has gone from always putting his bad leg over first (which he was taught by Shari) to being able to put either leg over first with pretty equal ease. And that means he is using the bad leg to support his weight both when it's forward and when it's back.

 

Shari was very excited to see that he could stand on his back leg to use his good leg to scratch his belly on Saturday and, since his seasonal allergies are noticeable, I get lots of chances to see him either stand on that leg or use it to scratch himself ("self-administered ROM exercises"?).

 

He has a very positive outlook, wants to be doing much more than he is allowed to do, and has been very cooperative. His exhuberance and enthusiasm for any form of activity (well, other than the ROM) makes it hard sometimes to make him settle down and be sedate, but I'm glad to see his personality intact and his energy at good levels.

 

He does get a bit stiff and sore sometimes after his walk and exercises but that is very transitory and soon gone. As Shari has pointed out, this is work for him and he is in the process of rebuilding muscle and fitness along with soundness. I'm very pleased with his progress and just hope to be able to do my part in helping to bring him along in regaining his mobility and function, as well as getting rid of pain.

 

I appreciate everyone's support!

[Sue R]

July 19 2012 - four weeks and two days post-op, third therapy session

 

There is no fear in Celt about therapy visits - he was whining and dancing in the car (to the limit his seatbelt will allow) as soon as we turned off Rt 40 to drive up to the therapist's. We had to go a bit earlier this week because of family plans on Saturday so he didn't get a full week in between appointments, and I braced myself for the probability that he would not have made much progress.

 

But, to my delight, Shari was very pleased with him. He is using his leg quite well for walking and, when he breaks into a trot, he also uses it. However, she pointed out that he should be kept at a walk because it's easier for him to "cheat" and favor the leg at the trot.

 

He enjoyed his cold laser therapy, just about melting off the dog bed with relaxation - interspersed with acting silly and wiggling, which made the therapy hard to administer. Apparently Shari is his new best friend, along with her magic machine.

 

She was very pleased with his range of motion, showing me where he had improved flexion at his hock, and increased stretch for all his extension exercises. She also gave me advice to make his three-legged dog exercise more productive, by shifting his weight slightly to his bad leg side so he was not putting his weight into my supporting hand that was holding up his good leg.

 

He showed her that his backing-up exercise is coming along. Not long or searching steps backward but improving and more even steps. But his cavaletti work was abominable! While he does that beautifully at home, leading with whichever leg is in the right position and not favoring leading with either leg, he just would not step over at Shari's. He kept cheating by hopping to one degree or another. I think he was just excited (and, since the threadmill comes after the cavaletti, and he loves the treadmill, I think he just was too distracted to pay attention) so we dispensed with that.

 

The new exercise was steps. We went to another room and he went up and down a set of "baby steps" or half-height steps, and did a very good job, not hopping but stepping up and down nicely. We tried the full-size steps but he was more prone to hop and so she decided to restrict him to the baby steps right now and not encourage bad work. We have two steps out home that he must negotiate going out and in, and we will just be careful to make sure he goes slowly and stepping, and not hopping. I really have to be on my guard to make sure he does it right or he will hop with eagerness.

 

And then there was the underwater treadmill. Do you think he was ready? He loaded himself when the door was opened and I'm convinced he was just wondering where the water was.

 

 

Come on now, people, let's get going here!

 

[Sue R]

Shari was also very pleased at his treadmill work, upping each of the three sessions to 2 1/2 minutes. Again, the water level is below his belly so as to work his legs without supporting his weight since he doesn't need that assistance, and her hand is just there to help keep him centered and in the right direction.

 

 

His stride was improved, more smooth and regular, without any very obvious difference in stride length. I really regret not getting video from the first session that showed how he was not extending his one leg forward; not extending that leg backward; stepping very high in his shortened strides; and always placing his feet under him to better support his weight (versus walking more "four-square").

 

 

This was his third session in this night's treadmill work. While at previous visits, you could see him tiring from session to session, he actually did some of his best work in his third session this night, showing an increase in strength, good use of all his legs, and in stamina. And he was quite relaxed, even trying to take a moment for a shake-off, which doesn't work so well when the treadmill is running!

 

A therapy session leaves him tired and sometimes just a bit sore the next day, but seeing improvement on a weekly basis is very rewarding. Considering that the surgeon's plan of activity for the eight weeks after surgery involves very little other than potty walks for most of that time, and seeing the progress that Celt is making with professional therapy, makes me see how valuable this is to help him improve in strength, balance, and overall recovery. And it is also aimed at strengthening his whole body to reduce the chance of other injury while compensating for the injured and repaired leg. Sounds good to me!

[Sue R]

Our at-home work remains very similar for the next week (twice a day) -

 

15-minute walk (I said "walk" not "trot", Celt!)

 

ROM exercises, all four legs, counting to eight

 

three-legged dog, both hind legs, six reps, making sure I shift the weight to his leg that is on the floor

 

walking backwards (two sessions, each about six to eight feet in distance)

 

cavaletti (12 step-overs at an 8" height - I do a figure-eight so that he is also bending in both directions and going both ways)

 

and then a well-deserved rest!

[alligande]

Thank you Sue for posting about Celts journey, it is fascinating

[Sue R]

July 25 2012 - five weeks post-op and the third week of therapy

 

Celt is making progress - we are past the point where progress is easy to see, those first few weeks after surgery. Now it's a matter of slow and steady to build muscle and strength and balance. But it is also frustrating not having obvious improvement markers visible every few days or even daily. It makes it much harder to gauge if improvement is being made, although I do believe I can feel and see improving ROM each week. I do know that he was totally silly when it came time for him ROM this evening - we had to pause several times for silly rolls and goofiness, which is not really that typical of Celt under normal circumstances, but I think it was an indicator that while he is not overly fond of his ROM work, it does not worry him any more.

 

I look forward to each therapy session with anticipation - wondering if Shari will be pleased with him, if she will find progress, if she will feel I'm doing a good job and doing things right, if he's looking like he's going to make it all the way back to sound and working.

 

He's come a long way from the dog who had to have all other dogs and distractions out of the room in order to relax enough to lie down and let me do his ROM exercises to a dog who can have anybody and everybody in the room (as long as there is no action going on that he might like to join). And, with his insecurity around Dan, I had to make sure previously that Dan was shut in his crate (out of sight) or in another room before Celt would even lie down for his ROM. He felt too vulnerable to relax - now, I can do all his exercises with Dan in the room and even with Dan lying down only a few feet away. If Dan does get up or come over when I am encouraging Celt in one or another of his exercises, all I have to say is, "Get out, Dan" and he moves away out of the area.

 

Dan has been wonderful, never pushing buttons, always being a gentleman and respectful to Celt, and making it so much easier for me and for Celt. He occasionally tries to get Celt to play and I have to tell him not to, but there are also times that Celt offers to play and I have to remind him that that is not on his dance card at the present.

 

Celt got a bit snippy with Dan the other morning, going over to Dan (standing on his bed in our bedroom) and snapping in front of his face. Dan just stood still and quivered one lip, hardly visibly, and I said to "Knock it off, boys" and that was it. Dan could have been watching for his chance to make a move and get after Celt when he would easily have been able to get him down and out, but he has done nothing of the sort, always being respectful of Celt and of me as I've endeavored to keep things on an even and peaceful keel. There are days I love this dog.

 

I had a good excuse tonight to cut things short, getting home with the grandkids after dark from an activity that involved other people and which time I could not change to suit my needs. But I made sure to feed the dogs, do the exercise walk, and do all of Celt's exercises, and it's done - no guilt. I have a fear that if I let myself miss just one session or skimp just one time, that I will get sloppy and lazy because that's just the way I am. He may or may not make it back to full service but I don't want it to be my fault if he does not.

 

Three weeks from today, and that will be our follow-up visit to the surgeon and xrays taken and viewed. I will be eager to hear what the surgeon sees and says. On the surgeon's post-op plan, Celt would barely be walking a block a couple of times a day by then, and no PT to speak of. I am sure all this work is going to make a world of difference in his recovery and rehab.

[Sue R]

July 28 2012 - 5 1/2 weeks post-op, fourth therapy visit (three weeks of therapy completed)

 

This part of recovery is almost harder to deal with than earlier stages. Why? Because earlier on, I could see progress on a rapid basis because he was going from very limited ability to move about to an obvious ability to move about. Now, it's more a matter of degree, slow building of muscle, improvement of range of motion, better balance, better striding - but progress is harder to see as it's much less obvious and oftentimes seen in more subtle ways.

 

My friend, Cindy, who last saw Celt two weeks ago, was pleased when she saw him (as she left with Anya) walking around in the waiting room but she could see that he was still not walking with an even stride - "Going a bit short on the right."

 

As usual, in the therapy room, Shari started out with observing Celt. I could tell by the smile on her face that she wasn't seeing anything to displease her and was seeing something that did please her.

 

I asked her to recheck the circumference of his hind legs to see what, if any, change there was. The first visit, there was a 4 cm difference. She was quite puzzled to find that now, after working for three weeks, there was a 5 cm difference. We both gave that some thought and I wondered if that might be because he had been on crate rest/very limited activity for 8 or 10 weeks prior to surgery, which meant a total of almost 10 to 12 weeks prior to his first therapy visit, and perhaps at that time, both legs were quite atrophied. And, now with exercise, the sound leg is muscling up more quickly than the unsound leg, and that might explain the increase in difference. To my relief, Shari felt that that was the most reasonable explanation and so was not worried about the measurement that was not what we expected. We plan on remeasuring in another three weeks to see if we then see the sort of improvement that we hope for.

 

She next did his cold laser/ROM exercises on the mattress. He tried a new diversionary tactic with her to put off the work, something he's tried lately at home with me - getting silly and goofy when he was told to lie down for his ROM, and rolling on his back and wiggling.

 

Part of that is that he is feeling better. Part is that he is happy to be "the only dog". And part, I do believe, is trying to put off the work that needs to be done that is not his favorite thing to do. I was very pleased to hear Shari say that his ROM is, in several of the exercises if not most, at the maximum range. In other words, with our daily work under her guidance, the ROM of his legs is flexed or extended at its full extent. That was good to hear. Next week, I will try and take photos to show that maximum range.

 

I was quite puzzled in that I was finding him offering only a little resistance with his injured leg (for the ROM extensions) but finding that he was resisting me much more with the sound hind leg. That seemed counterintuitive but, as Shari pointed out, it is because the good leg simply has the greater strength to resist the manipulation.

[Sue R]

July 28 2012 continued

 

Shari next did the three-legged dog exercise. I have been trying to shift his body to keep the weight on his unsound leg but am only successful about half the time. She saw minor improvement here.

 

In Celt's walking backwards exercise, Shari was pleased to see that he was using both hind legs more evenly and stepping back with an improved and increased stride. The first time we did this, he did more of a shuffle back than steps - by now, he is definitely stepping, even though the strides are fairly short. A good improvement in this exercise, then.

 

We've had problems with Celt and the cavaletti at Shari's - he has gotten so excited that it was almost time for the underwater treadmill that he has had problems with hopping over rather than stepping. Today, fortunately, he kept calm and virtually all of his steps at 8" were steps and not hops. Then she raised only the center bar to 10" and we tried that, but he is still not quite ready for that as he was even having to do a sort of one-leg hop to get over. So we are to stay at 8" for now.

 

On to the steps, where he again did the baby steps (half-height steps) very nicely. And, he did do a couple of up-and-downs (four steps each, I think) of the regular steps nicely but began to tire and start to hop, so we ended that exercise.

 

And then, everyone in the pool! Here is a front video (I forget that I don't have the software to rotate the video so I started out wrong and fixed the orientation of the camera):

 

 

He's steppping more evenly, more straightly, and more strongly. Here is a side view (I have trouble getting a good side video because he wants to watch me and then he does not stay straight, so that is why I did not get this at a 90 degree angle):

 

 

Shari was very pleased to see that he is stepping better and better each session - longer, more even, straighter, better weight-bearing, strides. He did three reps of 2 3/4 minutes each and has tired less each week, even though each week, the time has been increased by another 15 seconds.

 

One last exercise was added - sit/stands. The important thing with this exercise is that I do not step back to "make room" for him to move forward slightly to stand. That defeats the purpose of the exercise which is to make him utilize his hindquarters more effectively. He still can't sit squarely - his bad leg sticks out to the side slightly, but his sit is improved (and we are not in any way "forcing" the sit but letting him sit as is comfortable). Each week, his sit has become more square (more evenly on the seat bones) and the angle at which his bad leg sticks out to the side is reduced.

 

Our work at home this week is now (twice a day) -

 

walking 20 minutes (about half is a significant slope and half is a very gentle slope)

 

ROM on all legs, six reps each, counting to eight

 

three-legged dog, both hind legs, 10 reps

 

walking backwards a total of about 12 feet

 

a dozen steps over the cavaletti (he's using both legs pretty equally well there)

 

six reps of sit/stand (which is treat time!).

 

It's been taking me about 1/2 hour solid time to do his work last week, twice a day. Now that will be more like 45 minutes from start to end. We go to the surgeon in 1 1/2 weeks, and I will be very interested to hear what he has to say about Celt's progress. Plus, he will take xrays to check on the healing of the bone, and I am interested in those results, as well.

 

Total outlook today - improvement is seen in most aspects of his work!