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sDo you know about the Goldilocks Principle? If not, read on because it will definitely help your dog. This information applies to all CCL tear dogs whether you've chosen conservative management (CM) or surgery.
Our goal is to give our pups the opportunity to return to happy, healthy, mobile lives. With CM and post-operative recovery we need to return them to activity slowly and carefully. When the surgeon says they're fully healed, don't be too quick to throw a ball and play fetch for an hour. Many people are so excited to see their dog run again, and they let them play without restriction only to see their limping return. It's disheartening after such a long recovery. The goal of this article is to walk you through figuring out how to carefully and systematically resume your pup's activity. The challenge lies in figuring out three things: 1) which activities can be done without lameness afterward 2) how often the activity can be done without suffering afterward 3) duration of time the particular activity can be done Deciding on exercise duration can be challenging because it can change each day and certainly will as our dogs age, so there are no absolutes here. It's more like an ebb and flow where you'll be flexible with timing. Some days they'll do a certain activity for 20-minutes and be fine and another they could limp for days after. That's because besides the activity there are other variables factoring in:
Let's think about ourselves and how we feel with exercise. When we're young and agile we can physically do what we want for however long we choose without much soreness afterward. We can hike in the Grand Canyon one day and easily run five miles the next. But as we age we learn to selectively pick and choose what, when and how long we'll exercise because if we ignore those things we'll suffer. Let's take that same approach for our pups. Here are some guidelines. Let's refer back to Goldilocks for a moment. She wanted to figure out the "just-right" temperature of her porridge or the just right softness of her bed. There's actually a multi-applicative term called the "Goldilocks Principle" and that's what we'll use to help our dogs safely get back to exercising. The challenge is figuring out how much activity is just enough to keep the dog healthy, happy and mobile. We've got to be like detectives and pay careful attention to look for signs of pain, not only during the day he/she exercised but for a few days after. Notice the duration of time and types of activities that cause soreness. Before exercising, start a countdown timer on your phone to keep track of the moment he/she begins favoring the leg. To keep track, take notes on paper or create a note in your phone. Signs of pain include (but are not limited to): panting, lying or sitting down, refusal to move, licking the leg and limping. If one or more of these happen at 20-minutes for example, then you'll try decreasing duration by 5-minutes and maintaining the adjusted duration for a week (unless they're struggling and you'll decrease by five additional minutes). Always re-assess. If they tolerate a certain duration, stick to that amount for a week or so before increasing duration, and when you increase do so by adding another 5-minutes. The idea is to continually assess and make adjustments as needed. We must also consider the physical challenge on our dog's body when choosing exercises. An example of this is a dog that limps after chasing a ball for five minutes versus being able to walk for an hour or more. Why does that happen? It's because playing fetch is comparatively harder on the body than walking. Here are a few more examples:
Paying close attention to duration, types and frequency of exercise will help you decrease the repetitive nature of pain flare-ups and remissions that can temporarily sideline your pup's ability be active. Following this method will help you minimize exercise-induced inflammatory response, giving you the ability to be more effective at controlling pain. Hooray, YOU! If your surgeon gave you exercise guidelines, please follow them or share these ideas to ask whether they're applicable. Leave a comment about how you safely returned your dog to activity!🥰
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It's bad enough to hear the surgeon say, "I suspect your dog has a torn CCL" and then on top of it we learn they have arthritis too. It's a shock for some people because they assume arthritis only happens to old dogs. Some believe it's caused entirely by the CCL surgical procedure. Neither is 100% true. In the many cases of dogs with CCL tears, degenerative osteoarthritis starts early on no matter how old they are and possibly well before they undergo a CCL surgical procedure.
Over time arthritis forms when there’s abnormal joint movement, and that's what happens in the case of a torn CCL (sometimes referred to as an ACL). With a torn CCL the dog's knee joint isn’t as stable as it should be. Without a stable anchoring attachment (an intact CCL) from the femur (thigh bone) to the tibia (shin bone) the tibia shifts forward (tibial thrust) during many normal canine activities and movements. As the tibia shifts forward, the back part of the tibial plateau scrapes against the rounded bottom part of the femur called the femoral condyles. This causes inflammation and pain. Cartilage thins eventually diminishing the space between the two bones. That’s what osteoarthritis is. It’s the body’s normal, unstoppable and natural attempt at repairing and stabilizing an area where normal joint biomechanics are faulty. Whether we're talking about pre-op dogs or ones recovering from surgery, their body is in healing mode. The problem is healing doesn't necessarily correlate with a perfect return to pre-injury status. Edema (swelling) infiltrates the injured area. Bone cells, called osteoblasts, are called in to repair bones. Slowly, they build pointy spur-like projections. These extra bone growths, called osteophytes, put pressure on adjacent tissues resulting in decreased range of motion and continued pain. Scar tissue forms which is less supple than normal tissue and yet another reason for decreased range of motion. There are things you can do to counter the symptoms of arthritis. These can be discussed with your dog's veterinarian and may combine various modalities such as weight loss, physical therapy exercises, laser treatments, acupuncture, supplements, hydrotherapy, massage, and/or prescription medication. You can modify activities to minimize added wear and tear on joints. This means reducing high impact activities such as those involved in playing fetch, darting, fast or awkward stops/starts, high-speed running and jumping. We should replace those with short duration walks, controlled jogs, scent-work games or hikes where we control the pace and direct our dogs to level ground and easily-traveled terrain without ruts, rocks, logs, sticks, etc... Keeping the fur trimmed between your dog's toes and under their pads helps arthritic dogs walk with more ease and confidence. Keeping their nails trimmed allows paws to contact and grip the ground which they can't do when nails are overgrown. Reducing slippery surfaces in the home by laying down carpet runners is another way to help your dog get around more safely. Replacing stairs with a ramp to get outside makes getting to ground level more comfortable for your pup. There are many more ways to reduce the load on your dog's joints. Rest doesn't erase arthritic change, but forcing an arthritic dog to lay around all day isn't helpful either. The challenge is in finding the sweet spot – which activity and how much of said activity is just enough to exercise your dog without aggravating their condition. An arthritic dog deserves to be engaged with his/her surroundings. They need to be emotionally and mentally stimulated, and it's our job to figure out new ways to achieve those things. No matter what anyone says, there's no magical cure – no supplement, no surgery, no medical treatment that makes arthritis go away. It's about modifying activities, maintaining a healthy weight, creating a safe environment, following the aforementioned grooming tips and managing arthritis symptoms in practical ways. Ask your dog's veterinarian or surgeon for guidance. ©RunAgainRover.com, May 2020 Everything’s going well with recovery until the moment you see or feel a bump at or around the incision. Let’s review some possibilities of what it might be, what you should do (if anything) and whether you should schedule an appointment with the vet. No matter what the questionable bump is, it’s wise to send some pics or a video to someone on your dog’s veterinary team. Bump #1: This one is typically located at the very top of the incision. It feels like a small round circle that’s the size of a pea or smaller. This can be where an internal incision is knotted. Sometimes it becomes less palpable over time. Keep a close eye on it, lightly palpate it each day to check for changes in size or tenderness. If it gets larger, call the vet and send the doc a pic or two. Keep in mind that the very top and bottom of the incision are usually the last to heal, so sometimes bumps like this hang out underneath an unhealed section of the incision, but it doesn't necessarily mean there's anything wrong. Bump #2: These usually exist toward the top or bottom of the incision where the skin gets folded. The area that’s sutured is tightly closed, and when your dog is in certain positions, their skin might fold over the top or bottom of the incision. Bumps like this are usually less visible when the dog is standing because their skin is stretched. In a sitting or lying position the bump becomes more visible. Bump #3: This might be a puckered section of the incision. This is usually seen during the first couple weeks after surgery when the incision is still pink and healing. It happens in a small section from one sutured spot to the next, and from the images I’ve seen, these bumps tend to be toward the top or bottom parts of incisions. There typically isn’t any drainage or redness present. The incision should still be closed and not pulled open. If a bump like this was closed one day and then looks to be separating from left to right, carefully read the info about Bump #7. Bump #4: Sometimes there are multiple layers of sutures, not just the ones you see at the surface of the skin. The outermost (visible layer) gets removed, but deeper suture material is made to be absorbed by your dog's body over time. Some dogs reject this material which triggers an inflammatory response and delayed healing. You might be able to palpate a suture reaction as a linear bump along the incision line. The doctor will evaluate whether to give your pet antibiotics or to surgically remove the offending closure material. Bump #5: Does it look like a water balloon and feel jelly-like? This can be a seroma. These are usually not infected and are sterile, meaning there aren’t any bacteria or white blood cells in the fluid. This typically occurs in dogs who do too much activity too early in their recovery. Can the fluid be aspirated to check if there’s an infection? Yes, but many docs don’t do this because puncturing the skin can introduce bacteria into what was a previously sterile area and then cause an infection. Can you do warm compresses or massage? Yes, but ask the doctor first. Some recommend both while others recommend leaving seromas alone. Your dog’s body will resorb the fluid without any intervention whatsoever. Does it need medication to heal? In the case of a one that’s not infected, no. Seromas that don’t resolve need to be checked by the doctor and might require antibiotics just to be safe. Bump #6: Do you feel a hard, immoveable object near the incision? It could actually be the implant or the hardware used to keep the implant in place (screws or pins). Once the incision is fully healed, the bump from the hardware isn't associated with skin color changes, heat emanating from the bump or drainage from it. Most times it's normal to be able to feel metal hardware, but if you feel a new bump and your dog is showing interest in licking it or if your dog has begun to limp again, it could be implant failure that requires a veterinary visit ASAP. Bump #7: This can form in the early or much later stages of healing, and by later, I mean after the incision is fully healed and the dog is many months into recovery. Bumps like this come on slowly and can quickly worsen. It might look like an inconspicuous small, red or pink nodule, but some are large, mushy or water-ballon like. It can look dry one day and quickly turn angry and red and then worsen to the point of oozing, weeping or rupturing. Sometimes the fluid that comes out might be lightly blood tinged and STILL be infected, so don’t be mistaken into believing that if there’s no pus there’s no infection. If there’s pus, the infection has been brewing beneath the skin’s surface for some time and needs to be addressed by a doctor ASAP. Look for redness around the bump, warmth emanating from the area, oozing or drainage or a foul-smelling discharge. Note whether your dog is licking his/her leg. Does he/she seem lethargic? Is there a change in appetite? Has your dog begun to limp again? Get pics of the area day by day and send them to the vet. Chances are that your dog will need to be seen by the doctor because bumps like this are indicative of infection. A bacterial culture does two things: It identifies the specific type of bacteria present, and you'll get an antibiotic known to control that particular bacteria. A broad-spectrum antibiotic might be prescribed, and while these drugs kill many types of bacteria they don't destroy all of them; this is why culturing is so beneficial. Monitor your dog's incision multiple times a day. And if your pup develops a bump get pictures and videos to send to a veterinary team member. Look for behavior changes in your pet. If you’re concerned, don’t wait. Schedule an appointment to have your dog seen by a professional. Some studies suggest that if one CCL tears there's a 60% chance (or more) that the opposite side could tear. Does it depend on the breed? Definitely. Breeds most prone to CCL tears are Rottweilers, Newfoundlands and Staffordshire Terriers. Does gender play a role? Yes, females have a higher prevalence of tears. Can it be caused by the dog over-using the opposite hind leg when the other is injured? It makes sense to me. Does it have to do with spaying/neutering? Yes; studies show that spayed or neutered dogs are more likely to have CCL tears. And even though some studies say there is a correlation between a steep tibial plateau angle (TPA) and its relation to CCL tear, some don't show a correlation. Overweight dogs are more likely to have all kinds of joint issues compared to ones that are agile and fit.
No matter the cause of your dog's CCL tear/s, let's review the anatomy of the hind leg. Consider the dog's tibia (shin bone) and femur (thigh bone). In certain breeds, the top of the tibia (tibial plateau) is steep and angulated with the front of the tibia being the high side and the back being the lower side. Think of it like a street that has a steep hill. The femur sits above the tibia and every time the dog performs the movements listed below, biomechanical stress is placed on the CCL.
Envision the steep street again, this time with some ice on it. Imagine a car parked on the incline with its hood pointing to the hill's apex. Under the car is a cable that attaches it to the street. The street is your dog's steep tibial plateau. The car is the femur, and the cable is the CCL. As the car slides backward down hill, it stresses the cable which then begins to weaken and fray. A similar set of events is happening to your dog's CCL. Because the CCL attaches to the femur and tibia, the repetitive front to back shearing action between these bones causes the degenerative tear process to begin. As the CCL frays or tears completely, the tibia excessively shifts forward (tibial thrust) and the femur excessively slips backward. The result is pain, limping, swelling and eventual osteoarthritis. Please share this post link on social media or email with someone who's dog is struggling with this injury. QUESTION: If your dog has bilateral CCL tears, how many months or years did it take before the second side tore? Please comment below. Your dog was given intravenous fluids during surgery, so he or she might not be interested in drinking for the first day or so post-op. Before you get overly concerned that your pup might be dehydrated, here are two simple ways to check for it:
Skin Tenting Test: How to do it: Using your index finger and thumb, gently pinch the skin at the top of your dog's head between his ears or in between his shoulder blades and look to see how quickly the skin flattens out after you release it. HYDRATED = the skin flattens out almost immediately DEHYDRATED = the skin remains elevated or "tented" for more than 2-3 seconds Check Their Gums: How to do it: Lift the side of your pet’s lip and gently run your finger along the top of the gum line. HYDRATED: gums feel moist and slippery DEHYDRATED: your finger sticks to the gums because they feel dry or tacky IMPORTANT: If you suspect dehydration, contact the primary care veterinarian or surgeon ASAP. Helpful tips for getting your dog to drink:
If your dog isn't interested in drinking but will eat (Hand-feeding sometimes helps): IMPORTANT: Choose veggies rather than fruits for diabetic dogs, and NEVER GIVE GRAPES AS THEY ARE HIGHLY TOXIC TO DOGS! Offer foods with high water content such as:
What did you do to entice your dog to stay hydrated? Please comment below. If this blog post was helpful, please give it a LIKE. Share this article's link in dog-related Facebook groups, on your own Facebook page or in dog-related sites. Thanks! ©RunAgainRover, May 2019 When my dog first injured his CCL, the research I did online was like being stuck on an awful rollercoaster ride. Slowly clicking up that first formidable hill one nerve wracking bit at a time was about all I could handle. I had no idea what was on the other side, but one thing I knew for sure was that I didn't want to look down once I reached the top. And there it was - the summit. The highest, scariest point where I was forced to make a decision. I couldn't stay stuck on that ride forever, but at the same time I was afraid to hop off.
My online learning began with a lame-o Google search - something like "dog knee pain". And there it was, more and more information that all pointed to one diagnosis - a CCL tear. I watched videos of dogs who sat, walked and ran the same way mine did. I searched for some magical cure that didn't involve surgery or spending a lot of money. I went to work, came home, ate, and got back online to search some more. And this routine became my day, everyday. I wanted to educate myself, but looking back, I'm pretty sure it was my pathetic way of avoiding making a move in any specific direction. For each successive day that he struggled, I felt another ton of guilt weighing me down. I went to the conservative management site - you've probably visited it too. It's the one with the incognito guy who scares the bejesus out of us by talking about how surgery is unnecessary and then rants about infection this or osteosarcoma that. Yeah, that guy. Well, mister, it worked. You sidelined me away from surgery not once but many, many times. You fed into my wasting so much precious time. I wanted to give conservative management (CM) a try. I did lots of things: Physical therapy exercises, cold laser treatments, a custom-fitted stifle brace, prescription medications and joint supplements. My dog liked when I put the heating pad on his leg and massaged him afterward, but any benefit was temporary. And that was the case for all of the conservative modalities. Had I started them sooner rather than taking on the almost full-time job of "online CCL injury researcher", he might've stood a chance. But I wasted time because I was too busy staring at my computer screen. SMH...you know what they say about hindsight. If I could go back in time and get a do-over, I'd have started the CM stuff sooner. If I was convinced it wasn't working, I'd have chosen surgery more quickly. And that's the reason for this blog post. It's not to push one procedure over another but to help you to put your fears and procrastination aside and to help you see the situation with clarity from the start. I've been asked so many times, "How did you KNOW when he had to have surgery?" I can tell you that there wasn't a crystal clear moment, it was a culmination of lots of things:
Did the opposite CCL tear? Yep. The odds are stacked against us on this one. If one side tears get ready, because while the percentages vary from one study to another, the likelihood of the opposite CCL tearing is somewhere around 60%. Even if the other side hadn't torn, he'd have needed surgery. I had two surgical consults, one for lateral suture and the other for TPLO. I decided on TPLO for the acutely torn side first and another TPLO eight months later for the other leg. He healed perfectly and without complications. Did I make the right decision to move forward with the surgeries? Absolutley, 100% YES. My little crazy man is back and better than ever! Here are some helpful hints I wished I knew when my dog first hurt his knee:
Best of luck to you! Please give this blog post a like if it was helpful to you. If you've been through CCL surgery, please leave a comment that could help someone else have an easier time. If you're in the beginning stages and have questions, feel free to ask in the comments section below. It’s the night before your dog’s surgery. You give kisses. You worry. You wonder. It’s time for bed, little buddy. Sleep well. Tomorrow’s going to be a big day – a chance for a new start.
You’re lying in bed. You’ve planned, prepped and talked about the recovery plan from every conceivable angle, but you’re still afraid. Part of you doesn’t want the night to end because that means tomorrow will be here before you know it. And so it is. Filled with the sickening mix of stress, fear and concern that everyone whose dog has had CCL surgery feels, you drive to the veterinary hospital and hand your baby off to the vet tech. Mixed in with all of the negative emotions is the one that outshines them all – HOPE:
Hope is the one to focus on. It’s okay that you’re stressed. It’s even okay that you question your ability to do this recovery thing the right way. Before you know it, week one will be over. It will be the toughest one for you and your dog. But each week gets easier. Soon your pup will get his/her snarky attitude back. Walks will get longer. The skinny chicken leg will get its muscle tone back. Your stress will reduce. You’ll think, “I’ve done a pretty good job with this!” Twelve weeks will fly by in a blur. And you’ll be the one cheering on the next pet parent who’s feeling exactly like you are at this very moment. Keep the faith. You’ve GOT this. As pet parents, we're in this together. We coach one another through. We calm each others' fears. If your dog has been through CCL surgery, please share some positive energy with those who have yet to go through it by leaving a comment below. If someone you know has a dog with an injured CCL, please share this post with them. Thank you. Did the homework and bought the best harness for my dog ✔︎ Waited for delivery day ✔︎ Removed it from the package ✔︎ Put it on a shelf and waited for post-op ✔︎ And that last step, my friends, is where things went wrong. Imagine: There's a heap of straps and you can't figure out how which clasp goes into which buckle. Your dog is still groggy from anesthesia. You try lifting and moving him. That didn't work. You tuck the straps under his body and then fish around for them. That didn't work either. You try lifting him, but it's difficult because he's heavy, in pain and can't put weight on the surgical leg. You get the message - Size the harness/sling while your dog is still mobile. Practice with it. Start inside the house. Have someone stand across the room with a treat as you guide him toward the treat holding the harness. Keep it positive with lots of praise and pats on the head. Practicing will be good for you too, because you'll develop skills to balance your own weight while also stabilizing your pup. Then practice outdoors. Learn how to take the sling on and off. I don't recommend having the dog wear it continuously as it can chafe and ulcerate skin. You'll get a silver star for getting him to pee outside with the harness on and a gold star if you can get him to poop! Here's the next most common reason that people have useless harnesses/slings. Some people are told they can hold off on buying one until they see how their dog does after surgery. I advise against this. It's better to have on hand and return it if not needed. Make sure you understand the company's return policy. Some veterinary hospitals send dogs home with a sling/harness. Here's someone's Facebook post:  Hopefully, when veterinary staff notices a small statured person or someone who might not be strong enough to carry or lift their dog, they'll recommend a harness and recommend that the person practices with it beforehand. The Facebook user felt "terrified". It's unnecessary anguish. And let's not forget about her dog. You know how it feels when you have to pee and you have to hold it for too long. It hurts!
When it comes to getting a harness, don't wait: Purchase one. Size it. Practice. You and your pup will be happy you did! If someone you know could be helped by this article, please share it. If what you read is helpful, please "like" it and leave a comment. We instantly fall in love with our new dog, and while excitedly choosing their leash, collar, toys and treats, the last thing we're thinking of is the cost of veterinary surgery. Quality pet food, grooming, doggie daycare, routine vet care, dog walker services...it adds up so quickly.
And it's all fun and games until someone hurts their knee, isn't it? Your dog is limping and has a torn CCL. You're not financially ready for any of it - not a custom knee brace, not physical therapy and least of all, surgery. The wonderful care you've given is overshadowed by feelings of guilt for being a bad pet parent. You think, "I adopted my dog. It's MY responsibility to pay for this stuff." You'd feel selfish and irresponsible asking for help. And with all of this emotional baggage, other bills are still rolling in. You can't keep up. You try getting Care-Credit, but you're either denied or can't get a credit limit high enough to pay for the care your dog needs. You've already got balances on other credit cards. Slowly, your dog's bills are costing more than your rent or mortgage payment. Now what?!? Don't underestimate the willingness of others to help, especially when it comes to animals. You can still pay for the majority of your dog's care, but why deny others the joy that comes from giving? Asking for help can feel uncomfortable, but I'd be willing to bet you've made contributions toward a good causes before, right? Do you remember how good that felt? There are reputable fundraising sites online. Campaigns are easy to set up, and it's easy for people to make donations. Post your campaign wherever it is that you socially hang out online: Insta, Facebook, Pinterest, If you're not into Crowd Sourcing online, how about these fun ideas?
You might just be surprised by the kindness of others, even strangers. Give it a try! If someone you know needs help paying for their dog's care, please share this post with them. And then share some love here by liking or sharing this post to your social media pages. Do you have any fundraising ideas? Leave a comment! Some dogs tolerate therapies and some don't. And then there are ones who accept it one day but not the next. This could be due to factors such as these:
When dogs don't like therapies they give us some or all of these signs:
If your dog is giving you signs that she's not happy with one or more of the therapies you're trying, do you know what you should do? SKIP IT. Really. Revisit it another day, and if you notice there's something in particular that she never tolerates, just omit it. Your dog will continue to heal, even if you don't use icepacks, heating pads, give massages or do PROM. Be patient with your dog. Never scold her for not tolerating things you're trying to do to help her. When you do therapies, stay calm and give your dog lots of praise and love. Keep the sessions relatively short in duration. Try to keep the environment calm and quiet. Best of luck! Does you dog allow you to do therapies? Which ones does he/she enjoy? Are there any he/she won't allow you to do? Please share your story by commenting below. If someone you know will be helped by reading this blog post, please share the link. Let's work together to help our dogs have smooth recoveries. Thanks! There are a myriad of generic stifle braces available online and in pet supply stores. When I was still in conservative management mode, I decided to purchase one for my dog. I read stellar reviews and just as many negative ones. That's how I learned that certain braces slip, twist, rub against the knee, irritate skin and slide off while dogs wear them. The last thing a dog with a torn CCL needs is a brace that causes more pain and dysfunction.
I believe that the best stifle braces come from companies that have a Certified Orthotist-Prosthetist on staff. These professionals have the deepest level of understanding regarding joint biomechanics, so their braces more effectively address and control abnormal joint movement patterns. I like braces that are specifically made by making a cast in the exact shape of the dog's leg; and then a brace is made specifically for each dog. Once made, the pet owner is educated on all aspects of using the brace. The orthotist will take the final steps to ensure comfort, fit and function. Wearing a brace won't heal your dog's torn CCL, but it will control the backward slippage of the femur on the tibia (which is how the CCL tears). When this excessive motion is controlled over time, scar tissue begins forming around the dog's knee joint. This is exactly what we're aiming for because scar tissue helps to stabilize the joint. It's almost like the dog has an "internal brace". This is a S L O W process. So, if you're planning to get a brace, you've got to commit to having your dog wear it for around 9-months and possibly longer. Scar tissue isn't like supple, healthy, normal tissue. As it forms, it can just as easily tear and break down. This can happen when dogs roughhouse, run too fast, jump, slip or fall. Having a dog wear a brace takes commitment on the part of the pet owner, not just to fit it correctly, but to monitor activity, keep track of how long he/she wears it and then giving the brace ample time so that the dog's body can build-up the necessary scar tissue. What has been your experience with getting your dog a stifle brace? Please share your input in the comments section below. * If you know someone whose dog has a CCL injury, please copy and share my website address with them. Together, we can can have a more far-reaching effect on other pets' lives. © RunAgainRover.com 2019 In 1978, a guy named Gabe Mirkin coined the term "RICE" (rest, ice, compression, elevation) for the treatment of human athletic injuries. Since then, we've all been trained - inflammation gets ice and rest. Well, guess what happened? He has admitted that using ice and bedrest after injury is wrong because it constricts vessels and tissues. You might be thinking, "Well he's talking about humans, not animals." And I'll gently remind you that we're a type of higher-level animal. Where there's injury, whether traumatic or surgical, cells rush to the area to repair the damage. These cells have the job of consuming debris and killing foreign invaders, such as bacteria. This happens in all animals, not only humans. Inflammation is a needed response, and animal studies have proven that trying to control it with ice actually hinders the healing process. Mirkin says that ice should be used when the pain associated with the inflammation is extreme. Because we're trying to help our dogs, and we're unable to discern the level of pain they're experiencing after CCL surgery, should we use ice? Sure, and that's why many surgeons recommend it in their discharge instructions. Ice safety tips: To avoid causing frostbite, please place a towel between the ice pack and the dog's leg, don't leave ice on for too long; ten minutes is safe. Don't use a heavy ice pack that will weigh down the dog's leg. Some surgeons recommend using heat right after surgery because it increases blood flow, which speeds healing. If you're unsure whether to use ice or heat, please ask your surgeon for clarification. Heat safety tips: To avoid burning your dog's skin, please place a towel between the hot pack and the dog's leg (even if the heating pad has a cloth cover). Don't leave heat on for too long; ten minutes is safe. Use a medium warmth or medium-high setting to avoid burning your pet, and test the temperature on yourself first to make sure it's not too hot. Periodically check your dog's skin for temperature and signs of redness. Warm is better (and safer) than allowing the leg to become hot to the touch. *** IMPORTANT *** IF YOUR DOG WAS SENT HOME WEARING A FENTANYL PATCH, DO NOT USE AN OUTSIDE HEAT SOURCE (HOT PACK, WARM COMPRESS, HEATED DOG BED/MAT) ANYWHERE NEAR THE PATCH. DOING SO IS LIKELY TO DELIVER HIGH DOSES OF THE DRUG WHICH MAY RESULT IN DEATH. https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4951416 Movement reduces inflammation wonderfully, so my opinion is that dogs restricted to crates will be safer in a sense, but they'll heal more slowly than those who have a small recuperation area set up to allow them a bit of walking (and no jumping/running). Again, if you're unsure as to whether to use ice or heat or whether to crate or have a small recuperation area, discuss it with the surgeon before your dog is discharged from the hospital. Here's the article link about ice versus heat if you're interested in learning more: http://www.drmirkin.com/fitness/why-ice-delays-recovery.html Did your dog's surgeon recommend ice or heat after surgery? Share your story below. Thanks! Don't believe everything you read online. I remind you of this because I've seen so many questions asking about how to remove bandages and bandage glue. The question is great. The problem is all of the BAD ADVICE people give.
Here are common things people suggest that you SHOULD NOT DO OR USE:
Here are three suggestions people give that aren't awful, but I still wouldn't recommend or use any of them:
Here are two awesome, natural, non-toxic things that remove bandage glue:
Have you used coconut oil or olive oil to remove your dog's bandage or remaining bandage glue? Leave a comment below. If someone you know has a dog whose incision is covered with a bandage, please copy and paste this blog link and share it with them. Thank you. © RunAgainRover.com A lot of people try preparing for their dog's CCL surgery by doing these things:
This preparation is excellent, but it's not enough. Where people go wrong is that purchases sit unopened until they bring their dog home from surgery. If you do this, you'll have no idea which items will work for your dog or not. Trust me, you'll want to know these things before you bring your dog back home from the hospital. PRACTICE using the items weeks before surgery day. This way if something isn't working you'll have time to order, receive and try something else, and your dog will have time to become acclimated to it. Here are the most important preparations along with the Superstar Tips you need to know. Get the recuperation station prepared: Put your dog's bed inside the area. Cover wood or tile floors with non-slip mats or interlocking foam tiles. If you're using a crate, put a non-slip rubber backed mat in there along with a dog bed or comforter that won't bunch up around or under the surgical leg. Superstar Tips: Help your dog learn that his recuperation station is a positive place. Give him some time nearby or inside the area with him. Give him a toy to interact with. At first try for short durations less than ten minutes. Leaving your dog alone in the area could create anxiety, so initially stay present and give him praise for being calm. In a few days to a week, try having him in the area without you being right there with him. Stay in the same room and every so often, give him praise or a treat to reward him for being good. The cone collar: Have him wear it for 5-10 minutes at a time each day before surgery. Superstar Tips: Have treats ready and ask him to do simple tricks while wearing the e-collar such as: giving you his paw, sit/stay, coming to you when called, asking him to speak (bark). The idea is that he'll get used to the sensation of the e-collar and how it feels on him as he moves about. Give him treats when he wears it without pawing at it and when he performs the tricks you ask of him. Don't initially leave him unattended if you've chosen an inflatable collar. Slightly lengthen his regular collar, and thread it through the loops along inner part that goes against his neck. If you don't have him wear his regular collar with the inflatable one, after surgery he could paw at the inflatable one and slip it off. If that happens, he might lick the incision, and that's the last thing you want to happen. If you choose something like the Comfy Cone, you'll want to get your dog used to it as well. It cuts off their peripheral vision, while the inflatable ones don't. The harness: Get it sized and ready to wear ahead of time. Superstar Tips: Put the harness on him without the long straps attached that he could trip over. Have some treats ready and ask him to follow you around in the house. This is a positive way to help him get used to the sensation of how it feels as he moves about. Then hook up the straps (if your harness or sling has them). Either set a treat on the floor across the room or in someone else's hand who's standing across the room. Hold the harness without lifting his back paws off the ground. Walk at his side as he walks toward his treat. This will help him get used to feeling some pull/tension. Then try lifting the handle or strap, but ONLY enough so the back paws just clear the floor. This will help your dog learn what it feels like to walk as you slightly lift his hind end. With this practice, you'll develop skills to become more coordinated and balanced as you help your dog walk. The final challenge is to have him wear the harness outside to pee and poop. When holding the sling/harness, allow the non-surgical leg to remain on the ground while he pees/poops, but put enough upward pull so that you're supporting his weight. Ramps: Ramps are best for homes with steps from the house to the yard and/or for people with heavy dogs and vehicles with loading areas that are elevated from the ground. The more stairs you have or the higher your vehicle's loading area is, the longer the ramp you'll need. In situations such as these, buying a short ramp will create too steep an angle for him pre and/or post-op. This could cause your dog pain. Always be by your dog's side to guide him because one slip or fall could be detrimental. Superstar Tips: Set the ramp flat along the floor and have him slowly walk across it to receive a treat from you or another person. I recommend having him leashed so he can't race across it. It would be safest to practice this on a carpeted area to avoid the ramp from slipping. Then practice with treats and the ramp going into your vehicle or up a couple stairs. Preparing BEFORE surgery day will make things easier for you and your dog. Lots of love and praise during these training sessions will surely help your dog. Good Luck! If your dog has had surgery and you'd like to add a helpful tip, please leave a comment below. Thank you. © RunAgainRover.com If your dog has had any type of CCL surgery, whether the repair is strong from the start (Ex: TPLO) or one that needs more time to heal (Ex: Lateral Suture Stabilization) you'll need to be vigilant when you're outside. For the first few days, your dog will electively move slowly. But don't be fooled; dogs that walk on three-legs and ones who are just beginning to touch their paw to the ground can move much faster than you think.
And this is where we see dogs aggravating the post-op leg. The owner takes them outside on-leash and something grabs the dog's attention. Before you know it, he's doing zoomies in the yard, pulling on the leash or standing on his hind legs with his front paws in the air. As if the post-operative dog isn't dealing with enough pain, many owners admit that while walking their dog is approached and being bitten/attacked or pinned to the ground by another dog. Your dog will instinctively try to flee the scene or if pinned under another dog, use his surgical leg to try and kick his way free. Each of these examples has the potential to cause setbacks in your dog's recovery. Be careful of these things:
Exercise your dog in a predictable place where he's familiar with the sights, sounds and activities there. This precautionary measure doesn't guarantee that your dog won't react to something he's usually okay with. Even the most relaxed dog can become hyper-reactive after surgery because he knows he's vulnerable and in pain and so might other dog that approach him. For that reason, I recommend staying as close to home as possible. Even if your dog seems depressed and you think that walking in a dog park would cheer him up, I highly advise against it because there are too many variables you can't control. If your neighborhood isn't a good place to walk and there are lots of distractors that will tempt your dog to run, jump or be reactive, then I recommend staying in your yard. Will it be boring? Yes. But can you more easily control the situation? Yes. Walk in the area that's the quietest and that has the least activity. Front yards have streets, vehicles and other walkers, but your back yard might be quieter, so walk there. If you have other pets, it's best to take them out separately. No matter where you walk, as you change direction, take wide angles as sharp turns are harder on your dog's sensitive, painful knee. If you walk in a neighborhood, and there's a house that has unruly pets, walk to just before that house and turn around. As the walk duration increases, you can repeat what I just mentioned multiple times so that you're still getting the right amount of exercise, but you're doing so in a way that minimizes the chances of your dog being reactive. Best wishes with your post-op outdoor jaunts. If someone you know has a dog who recently had CCL surgery, please share this blog post with them. If you've experienced or heard of a post-surgical dog getting into trouble or injuring himself on a walk, share the story by leaving a comment below. © RunAgainRover.com I'll have to fight the urge; I promise to write this entire post without inserting the poop emoji!
Let's get down to business. Your dog fasted before surgery and hasn't hasn't been overly interested in eating or drinking since you brought him home. He's peed, but all you're waiting for is that magical moment when he finally poops. When my dog finally went, I'm pretty sure that I was happier and more relieved than he was! What's the deal with that? After surgery, why does it take days for them to go when they normally poop once or in some cases, multiple times a day?
Here are some things to help make the magic happen. With certain food choices listed below, you might have better luck hand-feeding as opposed to offering them in a bowl: Bring the water bowl to him/her. If your dog lying down, tilting the bowl forward will make it easier for him to drink. Canned dog food Plain yogurt Fresh veggies Fresh fruit such as apples, watermelon or cantaloupe. No grapes! They're toxic to dogs. Low sodium chicken/beef/turkey broth cooked lean ground meat Scrambled eggs Bone broth without onions or garlic Small amounts of canned 100% pure pumpkin QUESTION: What did you offer your dog to help him/her have an easier time pooping? Please comment below to share your advice with others. It's consultation time. The surgeon's attention is all yours, so make the most of it by asking the right questions. Rather than wasting precious time taking notes, you can ask more questions if you use your phone's voice memo to record the answers. Be courteous and if recording without previous consent isn't required in your state, please let the doc know you're doing this. NOTE: You don't need permission to record in many states. The exceptions to this are CA, DE, FL, IL, MD, MA, MT, NV, NH, PA, and WA. You could print this blog and give a copy to the doctor to read the questions himself/herself.
**Do a few test runs at home to make sure you know how to turn your phone's voice recorder on and off without deleting the entire conversation. To be safe, if someone is with you during the consult, both of you can record the conversation. Questions:
© RunAgainRover.com, February 2019 I'm envious of people who have relaxed dogs. These are the pups you see at outdoor cafes lying comfortably while their owners sip drinks or enjoy a bite to eat. They're the ones that when taking walks care more about getting a "You're a good boy" glance from their owner than they do about the squirrel who just darted across their path. This is not my dog. Vincent is 100% spaz.
I knew to ask for a sedative after surgery. It was part of my pharmacologic arsenal and just as important as the antibiotic, anti-inflammatory and pain med. I know this because as day turned into night, he became restless. He had difficulty settling and staying asleep. Because the majority of healing process takes place during sleep, I believe that administering Trazodone before bedtime for the first couple weeks after surgery was an integral part of Vinny's recovery. Now imagine this: It's Friday and you're excited because your dog had CCL surgery and today's the day you get to take her home. You get discharge instructions and get her settled inside. Things are going along smoothly and you think, "This isn't so difficult. What's the big deal?" And then the shift occurs. It's 2 AM, and everything is changing. Your once calm dog is now whimpering, howling, pacing and panting. Your efforts to console her aren't working. You're frantic and ask yourself, "Why is this happening? What am I doing wrong?" The veterinary hospital is an hour or more away. You have no option but to wait out the night with hopes that the surgical center has Saturday hours. If they don't, it's going to be a very long weekend for you and your dog. Stories like this aren't uncommon. I've read them countless times in CCL Injury Facebook groups. And for this reason, when I advise people, I ALWAYS recommend that they ask the surgeon for a sedative such as Trazodone. You might say, "But my dog is chill. She won't need it." My response remains the same. Every surgery is different, so even if your dog did well after a previous procedure or he/she has never had surgery, STILL ask for the medication. You'll be happy to have it and not need it versus being stuck without it. Was Trazodone prescribed for your dog? Please share your experience with others by leaving a comment. Thanks! Thank goodness for brand-new shiny stuff, right? New products and new surgical techniques are invented all the time. We're led to believe they're better and that we'd be foolish not to choose the latest, greatest thing. If you've got a new cellphone or computer, you appreciate innovative products. You're okay with the fact that they might have little bugs or glitches can easily be fixed with a simple update.
But what if we're talking about a new surgical technique being recommended for YOUR dog? That changes things, doesn't it? If you're wondering why, keep reading. The usual surgical procedures for CCL surgery are the ones you read about and hear about most often. Each has earned its reputation based on the number of times it's been performed and the surgical outcomes it provides. The most commonly performed ones are: TPLO, TTA, Extracapsular Lateral Suture Technique and tightrope repair. No matter which one you choose, new or time-tested, understand that complications can occur with any of the procedures. No surgery comes without risks. We just want to minimize them as best we can. What if it's time for your surgical consult and the doc recommends CBLO or another newer procedure? If this happens, you should ask lots of questions. Technique refinement, assessing the benefits and risks of using newer metal implants, screws, etc... means there likely aren't as many surgeons performing those procedures or using the newer type/s of implants. This means less dogs are having these surgeries and the data is lacking compared procedures to that of procedures that are considered the "gold-standard" of care. If a newer type of procedure is recommended, ask the surgeon these questions:
I have read about non-Board-Certified doctors who learned how to perform advanced orthopedic procedures who then offer reduced surgical costs. Perhaps they charge less in exchange for their inexperience? While I can't speak for them, my opinion is to choose a doctor whose expertise came from years of rigorous, specialized training. Please do your homework, and don't be too quickly swayed by that which is bright, shiny, new (or less expensive). I am compelled to share the ideas in this post based on conversations I've had with others who were misinformed at the expense of their dog's lives. Have you had experience with a new technique? What was the outcome? Do you have words of wisdom to share with others? Your comment will inform other dog owners of your experience, so please share your thoughts. Herein lies the burning question and the one fraught with so much debate. All you want is direction, some quality advice to help you carve out a clear path to help your dog. You put it out there, and that's where things go a little haywire.
Biases are bandied about, and it seems like one person's advice negates the next. People say: Conservative Management (CM) is the best solution. TPLO is the strongest fix. Lateral Suture has less complications. Just say no to CBLO. Medications have too many side effects. Don't waste time with CM because your dog will become arthritic. Arrrrgggh! Stop. Take a breath. Exhale. You'll figure it out. Consider your dog's activity level: Is she a couch potato who loves lounging on her bed in a sunny spot or is she happiest running and playing? A sedentary dog's pain might be controlled well enough with prescription meds, joint support supplements and some physical therapy modalities. An athletic pup might do better with some conservative measures but might also require a more permanent surgical repair. Have you gone for surgical consultations yet? I highly recommend this, and not just for one type of procedure but two. I was fortunate because the first vet I consulted with is honest. Dr. Karen Kohler described the lateral suture repair in depth. That's the procedure she does most often. But she didn't stop there. She recommended that I go for a second consult with Board-Certified surgeon, Dr. Catherine Popovitch, to discuss the TPLO procedure. I took Dr. Kohler's advice. I learned about TPLO. Armed with facts rather than opinions, I had the tools to make an informed decision. Although my dog isn't one of those agile flying frisbee catchers, he's an adorable, spazzy little bruiser who weighs 80-pounds. I felt better about the stronger fix - the one that would be strong from the start, so I opted for TPLO. Has your dog's lameness worsened over time? This happened to my boy. His left CCL was the first one to go. I tried everything: a custom fitted brace, physical therapy, medications and supplements and cold laser treatments. He got short-lasting results. But some dogs do really well with these conservative methods, so it's not a problem to give it a try for one or two months. Then you can re-assess to decide whether surgery is needed. What might happen if you hold off surgery: When one CCL tears, the biomechanical stressors your dog places on the opposite hind leg is what can begin the degradation of the other CCL. There's a 60% chance that the other CCL will tear, and that's the reason some docs recommend surgery right away for CCL tears. Even if you have surgery right away, it's no guarantee that the opposite CCL won't tear. What about arthritis? When the CCL tears arthritic change happens as a result, so yet another consideration is the amount of arthritis your dog has. Arthritis and some degree of soft tissue swelling can be seen on X-rays. Contrary to beliefs, X-ray cannot be used as a 100% diagnostic indicator of a CCL tear. This is because ligaments, which the CCL is, don't show up on X-ray. It's the presence of Drawer Sign (an orthopedic finding that shows instability or the degree of slippage in the knee joint), the presence of medial buttressing (swelling near the inside of the knee joint), rear-leg lameness and the way that the dog sits with the injured knee winged-out to the side that indicate CCL tear. You do not need to pay for an expensive MRI to prove your dog's CCL is torn. Consider possible complications: When you go for surgical consults, ask about the benefits AND negative outcomes such as: plate rejection, the incidence of secondary traumatic fracture, infection, and material breakage such as suture material failure, screws backing out or screws that break... As with any surgery, there can be serious problems afterward so you want to be sure that you're thoroughly informed. I hope this article answers your most pressing questions. Are you struggling with the decision between moving forward with surgery or trying CM instead? Leave a comment below. I'm here to say that I understand you. You and I, we're legit dog people. That's why you're reading this blog post.
I remember how I felt when my dog first injured his CCL. There was always a smoldering, underlying worry about my dog before and after he had surgery. Do you know why? It's because all of the reading and researching I did was never enough. For every answer I received, I had a new question to ask. I didn't know what I didn't know. And that's HUGE. How do you learn those things? You figure it out by going through it. The problem is that you want to get things figured out now. You don't have time to waste, and you certainly don't want to learn the hard way by making mistakes. I get it, and that's where I can help. My dog had two TPLO's. I'll get you through the hard stuff. I'll save you the time of having to sort through the biased and sometimes inaccurate info that's being thrown around online. I'll help you get to the bottom of things so you'll feel better about the decisions you're about to make for your dog. There's a lot of misconception out there. Helping your dog deal with a torn CCL conservatively isn't rocket science. Going through a post-surgical recovery with your dog isn't as difficult as you might think. Can you do it if you live alone? Yes. How about if you live in a small apartment with stairs? Yes, you can do it, too. What about if you have a large dog and you're a small person? Guess what - you can handle it! No matter who you are, no matter where you live and no matter what breed of dog you have, it ALL comes down to one thing. Preparedness x 3. A successful recovery for your pup has everything to do with how prepared you are BEFORE surgery. What's preparedness x 3?
So relax - you've GOT this! And if you don't feel confident that you're ready, come back to this site to check out new blog posts. Let's have some great convo here. Leave comments and ask questions because if you're wondering about something, you can guarantee that someone else is too. And you never know, I might just use your question as the topic for the next blog post! |