2/15/10 - Off leash for 12 minutes

My plan was to let her run at the dog park for 10 minutes. I watched the video on slow motion later. She was using the leg better than I thought. I'll let her rest tomorrow, then do maybe 15 minutes on Wednesday. I took her to the clinic just for a fun trip. She was a bit stressed last time. I took her there and had their staff give her yummy treats. She even got a t-shirt that says, "My family loves me, as much as my doctors do at..." No kidding.

Slow motion:


Tunnel exercise - work on the knee joint and thigh muscle

Paws-up exercise


Standing on rear legs

1/12/10 - First time off leash

It was wet, cold, windy and nasty so I figured nobody else would be out. I took her to one of her favorite off-leash parks. I let her run free for 7 minutes. I wish I could have let her run longer but we have to take it slow. It made me so happy to see her happy!
I took her home and let her soak in a warm bath for a little while. My bath tub is not deep enough so I have her down-stay while I gave her bits of kibbles.

I started her on Vertex. I also switched her from EVO (42% protein) to Innova Senior Plus (22% protein) recently. I switched her since she doesn't get as much exercise as she used to. But now she's in rehab, I wanted to try Vertex for a short period of time.

Off topic but I found these great treats while searching for Vertex. It's organic, "human tested!" and made in USA. The chips smell great, hard enough to clean the teeth, low fat and they are huge! I'm ordering more.

2/8/2010 - Post OP X-rays

OS was pleased with the xrays. He told me that he did everything he could possibly do as an OS. Now it's up to me and her. Build the muscle and re-train her to use the leg more. He said swimming, running, playing are all fine now, just increase the amount & intensity gradually.

I put on her bootie (with coins inside) when I took her to the clinic. He likes the idea and he sees that it helps.

It's been almost 17 months since I noticed her first hopping. I can't believe a young Border Collie could put up with this so long. Such a patient girl she is.

1/11/2010 - Suture removal

Took her back to OS and had her suture removed. He was pleased with the way she's healing and the fact that she bends her knee when she lies. He told me 30 days post surgery before I start exercising/swimming her again. I am allowed to walk her on leash 3 x 15 minutes per day. I told him that there was no way I could keep her quiet all day long in the house. He said a little of running and jumping (onto a couch/bed) in the house is okay.

Final xrays in 4 weeks.

Muscle atrophy:

Left thigh - 13 inches, Right thigh - 10.8 inches

12/30/2009 - Post surgery

I was expecting something similar to post-TPLO. It was so much easier with this surgery. She was able to go potty right away. It took her almost a day after TPLO. She was awake (no morphine patch) and happy. The best part was that I didn't have to put the e-collar on her at all. They put a bandage on the surgical area so she cannot lick it. That was a HUGE help. It did take a bit longer for her to start putting weight on the leg - 4-5 days. Pain killer, anti-inflamatory and antibiotics for 2 weeks.

TPLO Necklace

12/29/2009 - Patella Surgey

I finally got to talk to the OS last night to discuss the options. I made an appointment for her surgery but I didn't want to give it a go unless I knew what he would be doing. He told me that TTT might be necessary, in addition to the other two procedures. He will not know until he cut her knee open. He will also try to remove the TPLO plate/screws and have arthroscopy done to see if there is any damange to her meniscus.

Update:
He did NOT have to do TTT. Turned out she had both medial and lateral luxation. The patella was sliding to both sides. He did limbrication (tucking in the ligament) and Trochleoplast (deepening the groove) then removed the TPLO plate/screws. Her meniscus was healthy and he didn't see any arthritis. (GREAT news!) I was actually surprised that they were in good shape considering how long she had this condtion for. Maybe the supplements helped? She stayed overnight. I was miserable without her.


More info on Luxating Patella on the web:

http://www.marvistavet.com/html/medial_luxating_patella.html

LATERAL IMBRICATION (ALSO CALLED LATERAL REINFORCEMENT)
This procedure alone may be adequate for a mild case but is often used as an adjuctive procedure to supplement one of the other surgeries. When the patella slips out of its groove, the joint capsule surrounding it is stretched to allow this motion. Imbrication simply involves taking a tuck in the joint capsule. The tightened joint capsule does not allow for the slipping of the kneecap and the kneecap is confined to its proper groove.

TROCHLEAR MODIFICATION
The patella rides in a groove at the bottom of the femur (thigh bone). In toy breed dogs this groove is shallow which allows the patella to slip. If the groove is deepened, the patella stays where it belongs. The normal groove in the femur is lined by slippery lubricated cartilage, called “hyaline cartilage”. This cartilage is peeled or cut away, the bone underneath is sliced out to form a deeper groove, and the cartilage is replaced. Techniques that do not preserve the original cartilage are no longer recommended.

TIBIAL CREST TRANSPOSITION
If the knock-kneed conformation has already started to set in, the tibias (or leg bones) will have rotated. In particular, the crest on the tibia where the thigh muscle (the quadriceps femoris) attaches, may have migrated inward. If this is the case, the crest will have to be removed and pinned back where it belongs to straighten out the leg. Severe rotation of the tibias may involve actually cutting through the entire bone and de-rotating it back into place.

Grade 2 luxations occur when there is occasional spontaneous lameness but the
patella returns to normal positioning easily enough that the dog usually isn't pained much by it. This is typically the dog that occasionally carries a rear leg for two or three steps on occasion but then puts it back down and goes as if nothing was wrong.

Most veterinary orthopedic surgeons recommend repairing dogs in Grade 3+ without question and advocate fixing grade 2 dogs frequently. So a 2.5 grade is probably one in which the examining veterinarian is leaning towards thinking surgery is necessary. That is just my best guess on the interpretation, though. It is better to ask the vet who made it. I think that most dogs generally get worse over time and move from Grade 1 to Grade 2 or from Grade 2 to 3, for example. The changes may not happen until later in life, though. A lot of dogs with Grade 1 or Grade 2 patella luxation early in life will have pretty stiff knee joints when they are 14 or 15 years old that probably are at least partially this way due to arthritis from the years of luxating patellae. There is a lot of other wear and tear in a long life so this is only a partial contributor but I know that some surgeons really feel that when the whole lifetime is looked at early surgery looks better. On the other hand, there are dogs who have bad 0utcomes from the surgery, too. I lean towards leaving knees alone until the Grade 3 stage, personally.

12/23/2009 - Warm water rehab #2

I'm still waiting for OS to get back to me to discuss the surgery options. Since swimming is easy on the joints, I decided to continue with the swim session. I took Cooper along today so that Jazzy could take a break.

12/18/2009 - contacted OS for surgery options (Patella)

Last five days, she has not been putting weight on the leg. I contacted OS's assistant to discuss the surgery options. I think her patella is completely out and she's unable to put it back. I know the OS wanted me to wait but I cannot possibly put her through this pain. If she has to have a surgery at some point, I'd rather get it done when she's still young. If I waited, she could develop arthritis, or her tibia can get shifted. If that happens, she might need Tibial Tuberosity Transposition. With age, the risk from anesthesia can increase too.

Hopefully she only need limbrication and/or Trochleoplast (deeping the groove) and not TTT. That seems too invasive.

12/14/2009 - Very sore

As expected, she was very sore the next day. I didn't give her any anti-inflamatory. I want her to feel the soreness so that she'd take it easy today.

12/13/2009 - First warm water rehab

Rummy's Beach Club

We had a blast!!! It was a little chilly but I was too excited I totally forgot about it. She chased balls and floated for 20-30 minutes or so, with frequent breaks. We loved Lisa's energy and we really enjoyed the session. This is so much better than hydro treadmill. I couldn't believe she actually floated. She never goes in the water unless someone is tossing a ball. I've always wanted her to just enjoy swimming, not always jumping, fetching and splashing. It is very therapeutic.

She limped quite a bit after the session. But the OS told me that's expected.

Another visit with OS 12/2/2009

After sending the hopping video, I went to see OS #2. Without the video, he would not have seen what I have been seeing. He said it really helped.

He felt that her knee cap was still loose. It is not even grade II. He explained to me different surgeries to correct LP but he suggested to wait. Since her muscle is weak and the ligament is looser, he suggested really working on building the muscle. Possibly it could help tightening the ligament. I recently found a warm water rehab place up in Spring TX. I had been looking for dog friendly pools with no avail. OS told me swimming and running would be good for her.

So no surgery yet. He ordered swimming for treatment...sounds good to me!

New videos

one of her worst day - few weeks ago. She usually gets better the following day.

I sent this video to my OS #2.

6 months mark after TPLO

Today is 6 months after Jazzy had her TPLO. She still hops and not putting much weight on the leg. I am becoming less and less optimistic about her complete recovery.


I will say that I am finally starting to feel okay about letting her run. I still cringe everytime I toss a ball. I am still very cautious when I let her play. Last weekend I let her fetch a frisbee for the first time in almost a year. She jumped and fetch gracefully a dozen times then failed to catch. I was only tossing it 5-10 feet away from me. She missed to catch and landed somewhat awkwardly. It was not a big "Oops" fortunately. I let her rest and gave her Deramaxx for a few days and she is back to where she was last week. I do encourage her to play tug with my other dog for wegith bearing but I micromanage. We walk off leash and do incline walks on leash. We do controlled freestyle as part of her rehab. We are really enjoying this.

I was really hoping that she would be back on rubble pile by now. Not sure if she'd ever get there again. Or maybe it just takes a little bit longer for her because of her muscle atrophy. When I did joint mobilization last night, it didn't seem to bother her knee at all. She was much more tense on the hip area. Maybe it's her hip or arthritis... OK, better stop before I get depressed.

Almost 4 months Video - Incline on Treadmill

She's now walking on incline at 8, at the same speed. She does this up to 15 minutes. I increase the incline and keep the speed and duration the same way. I want her to really push the leg down and work on the muscle. I put the wires behind her to see her extensions.

3.5 months post TPLO update

On the 10th week I took her to the dog park and let her run for a short period of time. The OS told me to do so 2 weeks post op but I decided to wait until 10th week. She did well. We did that again for 5 minutes two days later. She looks a bit sore that day. I rested her the next day and gave her NSAIDS. We continued with walking, treadmill, rehab and some running in the backyard. When she’s at parks, she likes to run full-on, then make a sharp turn to come back to me. I was afraid that the turning could reinjure the leg.

She has been doing so well except for the hopping and occasional soreness. The same hopping that got me noticed the partial tear in the first place. She does it mostly when trotting, stopping or turning. This is the only consistent thing in the past 10 months. Her bone is healed and I didn’t understand why the hopping was still there. Worried that there might be some other issue, I contacted my OS. Via email I explained her condition and my concern. They said that she could be having a plate sensitivity and removing it could possibly fix that. I didn’t notice any swelling or infections but if that’s the case, let’s have it removed.

I took her to the OS yesterday. He was actually very impressed with the way she was using the leg. He agreed that there was no sign of infection, therefore not to remove the plate. He also said that only about 5% of TPLO dogs end up removing the plate. So it’s not that common. He checked the mobilization, her illiopsoas and other areas to rule out other issues. He concluded that it was a habitual hop. She’s been doing this for so long, it has become a habit physically and mentally. He told me to basically let her run and play more. She needs to stop thinking about the leg and just use it. It is only natural for her to be sore until she builds up the muscle. (by the way, she gained back about ¾ of 2 inches of muscle in the last 3 months) Just like humans, the dogs will be sore after exercising. I thought about the pain on my inner thighs after the horse riding the other day… He told me to give her NSAIDS before or after the exercise. I decided to give that a chance. I’m still scared to throw a ball. She takes fetching very serious (Border Collie) and I don’t want her making the quick turns. Yesterday I let her play in sprinkler while I watered the lawn. That’s one of the few ways she’d trots and run lightly. She likes to run and catch the falling water.

10 weeks post op - 15 minutes of heaven

She has been on treadmill everyday, working on the muscle gradually. I decided to take her to a quiet dog park and let her run for the first time. It's been over 10 months since she runs freely. She did really well, no limping or skipping. I let her spalsh in the pond but no chasing a ball yet. The OS said to let her run or chase balls straight line. That's a little hard to control. So I just dropped a ball in the pond so that she can pounce on it. The best 15 minutes in months!!! I've been watching her after the exercise and she doesn't seem to be sore at all.

PT plan for the next 3 weeks & Measurement

8th week

• Treadmill – incline 0.5, speed 3.0, duration start at 7 minutes then add more at 1 minute increment
• Back leg exercise – walk over my legs forward, backwards, sideways (up to 5 minutes)
• Push-ups – Sit/Down/Stand
• Walking – 10-15 minutes on leash
• ROM

9th week

• Treadmill – incline 0.5, speed 3.0, duration start at 7 minutes then add more based on progress
• Back leg exercise – walk backwards, sideways (freestyle)
• Stand on back leg, paws up on a stall
• Balance – Sit pretty on unstable surfaces
• Walking – 15 – 20 minutes on leash
• ROM

10th week

• Treadmill – incline 1.0, speed 3.0, duration start at 7 minutes then add more based on progress
• Back leg exercise – walk backwards, sideways (freestyle)
• Stand on back leg without stall
• Stairs with harness for support
• Walking – 5-10 minutes off leash!

Measurement of her thighs
6/1/09

Middle of thighs (laying on the side)
R: 10.5 inches L: 11.5 inches

Top of thighs (laying on the side)
R: 12.5 inches L: 14 inches

Top of thighs (standing)
R: 11 inches L: 13 inches

Below are videos from her previous PT (illiopsoas strain)

Beg position on an unstable surface (for the core muscle)

Banzai (Stand and beg) on an unstable surface

8 weeks - PT begins

After the x-rays, I 'graduated' her from the confinement in the bedroom. She is now penned in the dining room where she can see outside as well as Cooper, our other dog. It's not wide enough for her to run. I set up a web cam and did a test-run over the weekend. She didn't run or try to mess with the x-pen. We'll do this for 4 more weeks or so before I let her completely loose in the house while we are gone.




I added incline on the treadmill. She really need to work on that muscle. We'll continue with the other exercises as well.

7.5 weeks post-op xrays

Jazzy had her 7.5 weeks post-op x-rays today. Pictures show that her bone has healed completely! Again, my OS is VERY liberal. He told me stairs, jumping on bed and some running were okay 2 weeks post-op, which I didn't follow. Today, he said that she could start swimming, running (straight) and go back to work within 2 weeks as long as I re-introduce them gradually. I told him that I would wait for at least 2 months before doing all that. I asked him about her chances of getting meniscus damage and other CCL injury. He said that since Jazzy's tear was partial, the risk is lower. Since she hadn't been running for the last 9 months, she lost tremendous amount of muscle in my opinion. I can feel it and see it. You can see that in one of the x-rays too.

It's a good day...time to go get some doggie cake to celerbrate.

More exercises

Sit/Stand

Weight shifting/bearing on stand