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

VPI SUCKS!!!

I've had VPI insurance on both of my dogs for years, never used it because I wanted to save it for bigger treatments like her CCL surgery.

I submitted a claim for Jazzy's surgery and out of $4600, they reimbursed only $300. On the benefit schedules, it says the allowance for CCL surgery is $1200+. I've heard insurance companies try to screw with you but didn't think this bad. I called them but they are having a 'meeting' and that I can only leave a message. I wonder if it's a norm and that unless you argue with them, you would only get the smallest money back. I've read something like that about other pet insurance companies but VPI was recommended by several people.

ETA: I finally got through with VPI on the phone. Turned out they made a 'mistake' and put it down as Hypertrophic pulmonary osteoarthropathy' instead of TPLO/CCL. yeah they are very similar condition, aren't they? Right... anyway, they will process the claim again.

Please let it be nothing...

I felt a small mass under her chin so I took her to the vet on Saturday. My friend's mastiff had a tiny mass, smaller than hers, earlier this year and She had to go through chemo. I have been more paranoid since. The vet said a mass like hers is usually benign. I asked him if he could do do biopsy or whatever they do to an unknown growth like that. He said her mass does not contain enough fluid like a lot of masses found on dogs therefore he wouldn't be able to do that. He said they would have to surgically remove it then send it to the lab. I wanted to do that right away but considering what she's gone though in the last 9 months (too much anesthesia), he recommended that we give her a little break and wait and see. I just can't take any chance. I'm going to have to do more research before I settle for the decision. Please please let it be nothing...


The white dots on the mass are her hair. I shave around it so I could see it better.

5/6/09 - Exercises

My vet told me to do stairs 2 weeks post op to encourage her to flex the leg. We tried that but regular stairs are too high and she wouldn't use each leg to go up. I really didn't feel comfortable adding stairs so soon either.

Another trainer who teaches agility (very into back leg awareness) suggested that I let her walk over PVC pipes or flat ladder on the ground instead. Here I'm using my legs as the ladder. This is how she eats half of her dinner each night. I use luring to slow her movements. I tongue click the second she lifts the leg up. I think this helps to reinforce the use of the leg, weight bearing, and strenghten the muscle. I do this after a short walk, for about 60 seconds, followed by icing.

Shifting weight on sit

I leg her lick half tube of canned food (EVO) while I have her do a clean sit then shift the weight slightly towards the right side. I make sure her right paw and hip doesn't stick out. I tried the other weight bearing exercises but she didn't enjoy them. I'd rather do something fun for her.

30 days post-op - treadmill videos

Angle view/Speed at 2.7

Side view/Speed at 3.0

you can see her right leg extending slightly less than the left leg (use the plugs as a marker)
She walked for 7 minutes. I saw her leg lagging for a second so I stopped there.

*sorry about my fingers. Too lazy to edit them out.

Just for a comparison, here's one with speed at 2.0
(I learned that some dogs are just too uncomfortable at slower speeds on treadmill. I think that's why she walked funny two weeks ago)

Top view/Speed at 2.7

The surgery leg still pointing out

And I gotta post her cute little butt

scary post on orthodogs

I don't think it was the stair that did it, more to do with chasing cat. It's a reminder to all of us...what a little chasing can do to their fragile leg. Poor dog :(((

Hello, my 11 y/o queensland mix just suffered a catastrophic failure of his TPLO and we are awaiting our surgeons verdict of amputation or repair. It looks very grim with the hardware failed,screws pulled out and multiple fractures.we were careful to keep him confined but were allowing 10 stairs at 4 weeks post op due to surgeon saying it was okay.we had an "oops" due to a short kitty chase and jump into a flower bed when he pulled off the leash. the stairs were only used 2x a day for potty breaks and seemed to be ok until this happened. I think the oops moment began the problem,no major symptoms but our boy seemed to not progress during the week following it then he collapsed on the stairs screaming(crying) in pain. Our hearts are broken and we feel totally responsible yet pissed at the surgeon who said stairs OK at the 4 week phase.All this days before the much awaited 6 week xray and possible return to his beloved walks at the beach.> I have read about the differing advice regarding stairs and write this to encourage others to NOT DO STAIRS! Also as I have read before here,... be hypervigilant for signs that progress has halted not just major signs like not weight bearing I think the oops moment with the kitty was what loosened things then the stairs finished it.> In conclusion has anyone else
experienced a TPLO failure of this type/magnitude and do you folks have any advice/referrals or any info about options here? Sorry for the bad news but really felt my experience would be good to post and we are desperate for info.

4/27/09 - signs of partial tears / video clips

Her gait before and after TPLO. Hit play to read.

4/25/09 - more treadmill videos

My friend's dog is going through the same thing. She had her TPLO four days after did. Her vet is more conservative than mine. The vet told my friend not to start PT until much later. He saw the video clips I posted a few days ago and noticed a major difference in our dogs' gaits. After talking to him, I decided to take it easy on the PT for a little while. I will continue with massages, walking, slow turning, some weight bearing/mobilization exercises, one low step using the curve (will post pic later). I need to be more careful in the house and in the yard.

ETA: Adela, I noticed that she is walking better in this video too. One thing I changed was the speed on the treadmill. First time was 2.0 and this time I set it to 2.5. It might have bee too slow the first time and that could be why she was walking awkwardly.

4/23 - Stress!

Jazzy started having really bad diarrhea. She woke me up every half hour, but once she was out, she couldn't go because of her leg. She kept spinning, lifting the surgery leg, even tried to go with both rear legs up in air. I took her to the vet yesterday and he said it was probably from stress. No parasites or other alarming symptoms. He put her on chicken/rice diet, Immodium and antibiotics. 2 hours after she took the meds with food she vomitted everything. I hoped that some of the meds were absorbed as I don't want her to be in any more pain. I can't take another sick day this week - had to take one yesterday as she can't use the petdoor right now. I am glad I stayed home. She wanted to go out every hour. I can't leave her with loose stool confined all day!

She finally stopped ringing the bell (her signal to go outside) at 3am this morning. I am assuming the Immodium did get absorbed after all. We finally got to sleep a little. She is staying at my second job during the day.

4/20/09 - very sore and walking funny

The doctor got back to me about Jazzy's gait/walk. He said based on what he saw on the videos/photos, he thought she was recoverying very well. I really hope this is only temporary... I started doing low step. I click and reward only when she uses the leg to go up, instead of hopping up. I use food as lure and click when she moves the legs separately. I also do weight bearing exercises but I can tell she is very uncomfortable. I hate this...hate to see her in pain. The worst part is I am the one who is giving her the pain during PT.

Sorry about the darkness but you can see how she points her right toes out more in this video.

It's at the lowest speed. She only walked for 60 seconds.

4/18/09 - Back to tethering/Weight bearing exercises

I tried to sleep on a futon on the floor with her but it was not comfortable. So I put up a barrier (x-pen) around a bed in the spare room so that I can sleep with her on a comfortable bed.


Still favoring the leg

She is still limping and not putting any weight on the leg. It's been going on since last Tuesday. I decided to limit her activity in the house to see if that's why. I take her out on short (3 minutes each) walks 5 times a day. If I let her loose in the house, she'd hop on three legs. It's really important that she learns to use all four legs evenly. I started doing weight bearing exercises.

(From orthodogs list)

1. Walk on a short leash, VERY SLOWLY


2. Stand with paws in a square position (front paws should be under shoulder, back paws should be under hips). Fix them if they are too far forward/backward, in or out.
   Make sure al paws are flat and not bearing weight on wrong surface (ie knuckling).


3. Touch affected limb to desensitize to touch.


4. Touch unaffected limb to “fake” him/her out.


5. Place paw in palm and gently compress, so he/she feels weight into paws.


6. Hold affected paw in your hand and stretch toe nails upward to stretch muscles of the pads.


7. Perform range of motion exercises.


8. Scratch bottom so he/she dances or wiggles gently (shifting weight from side-to-side).


9. In standing gently/slowly rock hind end side-to-side:
   With support under belly
   Without support
   With a folded towel under affected paw
   With front limbs on a step


10. Don’t be afraid to ask them to sit.


11. In standing, gently touch affected limb to encourage it to bear weight.


12. In standing, gently pull at ankle/elbow to place paw on the ground.


13. In standing push towards the non-surgery leg, to encourage a “push back” to the other side (to increase surgery leg weight bearing).


14. In standing, have him/her look:
    Up
    Up and side-to-side


15. This will shift weight back and to the side. Treats may help.
    · In standing, gently/slowly rock body forward and backward.
    · While walking slowly on a short leash, gently but firmly push down on top of pelvis to increase hind limb use.
    · Do not let both limbs move together in a hopping motion. Practice reciprocal steps.
    · Discourage three legged gait as much as possible.

4/17/09 - Something is off...

I noticed something off with the leg two days ago. When she walks or stands, the leg sticks out more. She has been a little more sore since Tuesday night. I gave her a bath (in a big grooming bath with rubber mat) that night. After I took her out of the tub, I saw her favoring the leg a bit. I have increased her activity level since Monday per doctor. She trots in the house and I let her walk on leash 5-10 minutes per day. I can tell she's trying not to put weight on the leg and maybe that's why the leg sort of sticks out as she's not bending the knee. She is no longer allowed to trot in the house until I hear back from the doctor. Another thing to consider is that she was on pain killer until last Sunday, which must have helped her with walking. Now she's off of it, maybe she's feeling the pain a little more.

LPL - Lateral Patellar Luxiation

http://www.workingdogs.com/vcpatlux.htm

4/13/09 - Cone Free!!! Several restrictions lifted

10 days post surgery. I took her to have her staples removed. The doctor was impressed with the healing progress on her incision and how she bears her weight. If she is walking slowly, you would never know she just had a surgery. She can now have a much needed bath, and have a cone-free life.

Activities for the next 6 weeks

I asked him how paranoid I need to be as far as her activity is concerened. If I have to, I can be as paranoid and strict as he wants me to be. But I'd love to give her more freedom if possible. The doctor told me to let her be in the house but I was worried about her jumping onto the couch and the beds. His response shocked me.

He said that I could start walking her 5-10 minutes per day (multiple times okay). Trotting, stairs, sit-down push ups, leaning out of the car window, occasional jumping on the couch are all okay. He also told me I could start doing rehab with her. I wanted to use a large portable pool instead of taking her to rehab pool once a week. He said that I could do that as long as she walked in a large circle slowly. Fill the pool to her shoulder. He told me to wait on this exercise for another week. I've read everywhere that all these exercises should be added at 8 week post surgery. I reminded him that it's been less than 2 weeks. He said that Jazzy's bone is already starting to heal and that the plate is already being utilized. I'm not going too crazy with the stairs and rehab just yet but I feel comfortable enough to add the leash walking daily. I thought she had to be kept quiet another 6 weeks so I am pretty excited about it.

4/10/09 - Fighting the boredom

Now she's feeling better, she is starting to get bored. I need to come up with ways to mentally stimulate her.

I let her hang out at the front yard when the neighbor's kids and dogs come out to play.



Bones and kongs are must



Tricks and little games that don't require her to move too much

4/09/09 - I want her hair back!

I hope her hair grows back quickly...

Incision is looking pretty good.

4/8/09 - Restricting activities

Until the staples are out, keeping her off of the leg is the highest priority, besides keeping her from jumping and running. She has been really good about not bothering the incision but I leave the cone on her if I can't watch her.

During the day she gets to stay at Rover Oaks

When I am in the kitchen, she is tethered - several tethering stations throughout the house



Jazzy's apartment.
The cone is off as long as I am there. Sometimes I stay in the pen with her and watch TV



In my home office - tethered




At night, she stays in a large crate, coned

4/7/09 - Redness is gone!

She is acting much better. The morphine patch might be wearing off. The patch is starting to irritate her skin. I don't know why it's applied on the right side. She is trying to scratch it off with her right leg (surgery leg). I cannot wait to take it off of her. She started drinking more fluid on her own but now she is constipated. I give her pumpkin and 1 table spoon of olive oil daily. I don't leave the cone on her as long as I can monitor her. Her bruices are looking better. Not too red and the incision is healing nicely.

I made an appointment for next Monday to have her suture removed. It would be the 11th day post surgery. I am so excited that she won't have to wear the silly cone anymore after next week!

4/6/09 - 3 days post surgery

She whined a little in the crate at night. She is staying at my second job while I go to my first job. I get to check up on her during lunch and if anything... someone should see it and give me a call. I am very appreciative that they are letting her stay during the day.

Clinic emailed me back and told me that the holes in the tibia are from the surgery. The doctor used them to stablize her bone while manipulating the bone. They also said that the morphine patch can cause the pupils to dilate, her to act differently and lose appetite for fluid and food. The redness is definetely the bruises. They should go away soon.

FENTANYL-TRANSDERMAL
SIDE
EFFECTS: This medication may cause constipation, lightheadedness, dizziness, drowsiness, stomach
upset, nausea or flushing the first few days as your body adjusts to the
medication. If these symptoms persist or become bothersome, inform your doctor.
Notify your doctor if you develop: irregular or slow heartbeat, anxiety,
tremors, seizures. If the area around the patch becomes red, itchy or irritated,
try a new site. If the irritation continues or becomes worse, contact your
doctor. When stopping this medication you may experience nausea, vomiting,
diarrhea, anxiety, or shivering. If
these symptoms persist or worsen, contact you doctor.

4/5/09 - 2 days post surgery

I never thought drinking and peeing would be this hard after surgery. She would take fluid only if it's flavored - whatever it takes for her to hydrate. She pees very little and it takes many trials.

Her leg looks really red and beaten up. The incision doesn't look bad but the skin around it look sore and red. I apply cold towel twice daily for 10 minutes. Her eyes are still dilated and she is still acting funny. She ate well. Bowel movement is normal.

I was looking at the xrays and notice two extra holes in her tibia. I am going to ask the doctor what they were for. I will ask him if the redness on her leg is expected.

4/4/09 - 1 day post surgery

Arthroscopy

Normal CCL - from google search for comparison

Jazzy's partially torn CCL - right side is still intact, left side has torn fibers and blood vessels



Again, right side is intact

I picked her up at 11am. She was hopping on her three legs when she came out. They shaved all the way up to her hip and her leg looked like a chinese crested. When I asked the doctor if I should tether her in the house since she is used to getting up on a couch. He told me she wouldn't be getting up due to pain. As soon as she came out of the back, she came to me and hopped up on a chair in the lobby. Great... She will need to be tethered in the house. He suggested not to crate her if I can monitor her. He says it's better to let her move around and stretch her legs. I got to talk to another doctor to go over arthroscopy images. He said that her CCL was about 50% torn. The knee cap was not screwed in but only adjusted. The doctor also "released" (put a small incision) the muscle that was attached to her knee cap so it sits right. He said that her meniscui was in good condition. That made me feel better. I was worried that the delay in the last 7 months might have damaged her meniscui. The arthritis is still mild.

She has her morphine patch on the side. I was told to remove it on the 8th.

Her meds:

Previcox 227mg for pain/inflammation - once daily
Cephalexin 250mg antibiotic - twice daily

On the way back home I noticed that she looked like she was dehydrated. Her tongue was sticking out and she looked like she had no control of it. She enjoyed some ice cubes in the car. I took her to my friend's house tonight since my husband was expecting a guest over at our house. I'd rather care for her where we don't have to worry about anything else. At 12:30 pm, I took her out but she didn't know what to do with the leg. She gave up and sat on the grass whining. I tried it again an hour later and she finally managed to pee and poop. I read it would take a while to have the first bowel movement. I had some olive oil, tuna in oil & can of pumpkin but I didn't have to use them. I was really happy for her! She drank very little water, ate some beef soup and rice.

She slept for 3 hours. I gave her more rice and meds at 8pm. She does not drink water. She doesn't even eat ice cubes. I took her out for potty three times but she didn't pee. She did poop again though. I was getting worried about her being dehydrated. She whined and panted on and off throughout the day. The good news is that she is already starting to put weight on the leg 36 hours post surgery. That is amazing. I have to be very careful not to let her walk fast. I need to go slow on lead so she'd learn to use all four legs, instead of hopping.

I took her out again at 12am and 1:30 am but no peeing. She is wearing a diaper all day just in case but she didn't have any accident. I gave her some diluted beef soup (no salt) and she finally drank! I should have thought of this sooner. She wears the e-collar all day except when I can be with her and watch her closely. She doesn't bother the incision yet. Her tongue is still sticking out. Her eyes are dilated. I think it's from the morphine. I made her really comfy orthopedic bed two nights ago. She looks pretty comfortable on it.

At 3am, I just saw her stretching both legs out like a frog. It's amazing how quickly she is adjusting after such an invasive surgery. I cannot CANNOT wait for the bones to reform so that I can start giving her more freedom again. It's going to be a long 6 months but I feel strong. This is so much easier on me emotionally than the last 7 months. At least I know what to expect. As long as I follow directions, it's almost guaranteed that she will be okay.

If all goes well, they will remove her staples in two weeks. Then they will x-ray in 8 weeks to see the progress. If it looks good, we can start adding some activities and rehab. Luckily, she gets to stay at my second job during the day. It's better than leaving her home. I don't want her removing the e-collar and mess with the staples. And I get to visit her during lunch and check up on her.

She finally went pee at 9am after holding for 19 hours!

4/3/09 - Surgery TPLO

She has no idea what was about to happen. She was perky and happy to ride in the car. She will spend overnight but I am not allowed to visit her. This is the first time she ever has to stay overnight alone. I took some soft blankets, treats, snuggle toys, and her meds with her.

They called me at 11am and told me everything went well. She was on morphine drip so she slept all day. She is not in pain, which is a relief. 3 people called me to give me updates. It was sad not to have her at home.

View my other blog - how we got here.

Originally it was misdiagnosed by the first surgeon. We went though 4 months of rehab, shock wave treatments and the whole nine yard. Turned out I was right from the start....she had a CCL tear. So this is where our new journey begins.

3/30/09 - Exam / CCL, TPLO surgery

Several months ago, she partially tore her CCL but it was misdiagnosed when examined (or at least that's what I believe). I knew in my heart that it was her CCL that was causing the toe touching. I did a research on CCL injury even before seeing the first orthopedic surgeon and I was prepared to schedule her TPLO surgery. He told me that her CCL was in good condition but she has an illiopsoas strain. (Note=partial CCL tears are difficult to detect from drawer test/x-rays. )He told me to put her back on anti-inflamatory meds and rest her. He told me that she might have to be on meds whenever she's sore. I was happy to hear that she didn't need a surgery but I wasn't happy about relying so much on the medication.

She never got better so I looked for a rehab facility. We went through 2 shock treatments, 4 months of serious rehab there. The hopping/toe touching never got better.

To make a long story short, it was her CCL after all. I scheduled her TPLO and LPL (knee cap) surgery for this Friday with a different ortho surgeon. Since partial tears are hard to diagnose, he will do arthroscopy prior to surgery to double check. I was so angry, upset, and sorry for Jazzy that she had to be in pain for such a long time. If she had her TPLO 6 months ago, she would have been running freely by now. I'm sure that the rehab was causing her more pain in the knee. She did everything I asked her to do. All the stairs, joint mobilization and treadmill were most likely hurting her knee all this time. I cried all day but we gotta keep going... I am ready to move forward with her. Please let this be it...

Previous blog based on the wrong diagnosis.

http://jazzypt.blogspot.com/