Pets At the Vets – Torn ACL Recovery – Part Seven

23 Sep

Pets at the Vets – Torn ACL Recovery – Part Seven

Sutures Come Out & Cleaning Day

On Tuesday, Sept. 20th, Casey’s metal sutures came out. Apparently painless, Casey didn’t seem phased. It didn’t take more than three minutes to remove the thirty-some clips. Now she was okayed to “lick” her shorn leg. The outside layer of skin had closed over nicely. Now we had to focus on her bone healing. I channeled Lassie or tried to – she was the postcard standard for calm, obedient dogs.

Friday, Sept. 23, 2011 – The Cleaning Team arrives this morning… and given how the dogs love to greet them, I have to be extra vigilant to prevent Casey from undoing her progress. I supposed it was like caring for an infant to whom you could not explain what was happening to her.  Casey likes to walk with the team through each room in the house, often stealing a sponge or dropped Kleenex. I had been cleaning the exercise pen myself since the surgery, but today I decided to let the pros take a swipe at it. There were remnants of knuckle bones and shredded fabric toys in nooks even I didn’t know about. They would find them.

I brought the three Golden girls into my office at the front of the house. It is to a comfortable and familiar place to ensconse them, albeit lured with treats. It was better than having them outside, as some pet owners must do given their space (fence) vs. work day constraints. It should come as no surprise, that pet surgery puts the onus on the pets human to pick up the slack — and stack the odds for a favorable surgical outcome.

Since I had been laid off, we knew when we entered upon Casey’s TPLO that I would be with her 24/7 until I found work. Also, we suspected I would need times outs from the stress of being ever vigilant. We factored in hiring one of our neighbor’s teenagers, Nikki, and working with our dog-sitter, Karen, to provide additional “in-out” access and companionship for the Goldens.

But back to the cleaning team, Maddie was still leery of vacuums, but her sisters were not. She tolerated the intrusive always growling machine. Sometimes she snuck outside until the team closed the door after them. However today, Casey was beginning to feel a “lot” better and it showed. Her pals knew she was rearing to play and were only too eager to accommodate.

As I write this, they have each staked out a square of carpet and are lying down. Since the minimum dose sedation meds still send Casey into la-la land relatively easily, though not keeping her snoozy for the full eight hours, we stick with the minimum dosage. Since we are both aware of the dangers of hyper sedation in people for long periods of time, we certainly don’t want that to happen to Casey. However we are cognizant of the dangers she could do to her bone without understanding what she’s doing.

We feel that Casey has figured out that she is on the mend. Of course what dog couldn’t figure this out after waking up in the foreign-smelling, scary Vet’s office groggy, shaved of fur in odd places, achy, and unaware of the circumstances which put them there.

From the way Casey’s paws “ran” in place while sleeping, I believe she dreamt of a romp with her pals across a beautiful field. All too soon, they will be up. Each  craftily contemplating how to get more treats out of me. Barking works. They will also give much thought as to how to fake me out as to when they have to go “outside,” what to whine at that will prompt a response from me (which might in turn generate another treat or at least kudos for their being such good dogs). This will be still a long haul. For Casey, me, and all of us.

Will Casey return to her Blue Ribbon Agility champtionship finishes? To the Rally-O she loves? Her evening walks? Will she run a sunny open field without limping? Will she be part of the seventy per cent of Retrievers who successfully make it through the post-operative process? Bone to bone healed to perfection? I will keep you informed.



Pets At the Vets – ACL Recovery – Part 6

22 Sep

On the morning of Sept 18th, Casey slipped a few paces ahead of me and leapt onto one of the elevated backyard planters. Damn. While only fifteen inches that was too high. Per medical notes, I lifted her down. She was not to jump down herself thereby putting additional stress on the bones we hoped were healing. We would have lots of “old” habits to break during her recover. All of us. That was one of my jobs. Not to let her risk the bone mending progress by preventing her from jumping up — or down. Retraining her to not jump gleefully onto one of the beds or the sofa, as she was used to doing. Hopefully I had not failed to watch my charge with her one quick leap. Casey had been such a compliant dog til now. Actually she still was. It was I who had let my guard down, if even for a moment.
Actually, Casey was a wonderfully good, well-mannered dog. To acknowledge why I must give kudo’s to Sue Myles ( of Orange County whose 36-years of cognitive “positive” reinforcement dog obedience experience certainly paid off for us with one of the best listening and communicative dogs we’d ever had the pleasure of sharing our lives with.  When we spoke to Casey, she would often cock her head one way as if trying to assimilate exactly what we were saying, weighing the pros and cons, and deciding to do it our way.
We had heard that Sue Myles was the go-to gal for all types of doggie obedience work. And everyone was right. Immediately upon finding ourselves in the middle of one of Sue’s beginning classes, Casey responded well. She was a fast learner. Under Sue’s watchful eye, all dogs were quick learners… as were their human parents. Sue was humorous and entertaining in her own right, but also very cognizant of the inherent dangers which could wait in bringing different breeds together, and made a point of letting us know that she grouped her classes accordingly. Immediately everyone felt secure being under Sue’s watchful eyes. And learn they did.

I see now that it is we, our pet friends, who must learn to read our four-legged pals so much better than we do. Sue made it seem eminently possible and not at all too formidable. And in short order she had all of our/her dogs doing things no one would have believed before class.

So now, after about four obedience semesters and having moved on to “Agility” with Sue’s friends Kevin and Erin, Casey was a model student. The timing was perfect. Casey was an “A++” student. So was Cindy. I mention this only in the context of Casey’s recovery. Since I’ve been with Casey 24/7, I’ve witnessed her inherent trust in both the commands she knows from us and her ability to appreciate “long down stays” and “go to your mat” have helped her greatly. She still gets to use her mind, even though her body is still enclosed in the exercise pen.
It’s hard to believe that she only had the TPLO surgery fifteen days ago. With her stitches out yesterday, Casey is now free to lick. And, we suspect, that’s just what’s she going to be up to as the new fur grows back.
Thank you, Sue Myles, for having created the opportunity for Casey and us to learn a “long down stay.” Already, this is holding her in good stead. While she probably does mind lying in the exercise pen for long periods of time, she knows that she is pleasing us. And, just to add a dollop of anthropomorphism in, I think she knows that we have given her the chance to walk, run, and do her beloved agility again.  It’s going to be up to us, the collective us, for the next few weeks. The two bones must grow together for her to heal properly. #

Pets At the Vets – Torn ACL – Part Five

18 Sep

Our Vet, Adam Gassel, DVM, of Southern California Veterinary Specialty Hospital in Irvine, CA, stressed the need for use of sedation for Casey upon her return home.  Since we do not have the ability to explain in hefty detail to our best dog friends what is now required of them, it is up to us to be their care giver. After all, they render us unconditional love. Why would we not return the love in kind?

While your dog will be sent home with antibiotics to help prevent infection, pain relief medications, and a sedative, it has been in my experience that the sedative is that which has been (a nd hopefully will continue to be) most helpful to Casey’s full recovery process. However I am not a veterinarian or in any way giving you medical advice, I am sharing with you Casey’s ACL experience in the hope that it may help you provide preliminary (ball park) diagnosis that “something” is amiss due to the “limping” you see, and, thus that you must take action. Your dog can not use a smart phone or text the vet that she or he needs help. They can’t make their way to the ER by themselves. So, again, this becomes a test of your true love for your dog. You set the ball in motion to fix the problem; you must take responsibility to see that your dog receives the best medical attention you can provide. And I’m not speaking “money” here, although the surgery is costly. It’s time. Your time. Your spouse’s time. Your children’s time. Neighbors. Friends. Other family. Anyone you can inveigh to help you help your pet.

However sedation is one of those great modern miracles which are “human” made. Thus it carries with it pros and cons unique to your dog’s size, breed, temperament, age, energy, and ability or willingness to understand the requirement for the very strict care you are enforcing on them.

Casey was sent home with “Acepromazine.”   Much has been said, written, journaled, and blogged regarding sedation in humans who are ill but not as much has been written and published about sedation of our pets post surgery in non-medical publications.  In the human world, sedation is clearly a good thing when used appropriately. We will focus in this blog on the appropriate use of sedation in Casey, my own concerns about potential mis-use of sedation, and my resolution regarding same. Others may disagree, but that’s your privilege.

When we first brought Casey home post-surgery, her eyes were glassy. She walked a bit like a woozy elephant. We lifted her into and out of our SUV. With each day, we felt more tempted to not over sedate her. To let her head and body be clear of the continued sedation. As the first days passed, Casey did not seem to much care. It was okay with her to lay in her pen and recover. However as the days moved into the second week, she was becoming more alert. Her two dog-mates had been keenly protective of her; now they wanted her to play with her. Clearly she wanted to play with them. Per Dr. Gassel’s rules, Casey had to stay calm.

So we delivered the next dose of sedation. After about thirty minutes, Casey became less amped and relaxed. The other two dogs followed her cue and lay down, too. This was a routine we would come to know very well. Helping Casey help herself. #

Pets At the Vets – Torn ACL – Part Four

18 Sep

Facts on a hand-out may state that it takes dogs approximately two months for their bone and surrounding soft tissue to heal. Highlighted is the case for “mandatory” confinement of our post-surgery friends.
Another of those inexplicable conditions of full recovery which we can not adequately share with our dogs is reduced playtime, movement, walking through the house, even on carpets, especially hard wood or tile floors. Even going to the bathroom must be controlled. With the cone on or off (your call), your best friend must be led outside at the appropriate times to relieve themselves. Care must be taken not to allow them to jump on a planter or change elevations suddenly. Keeping them on a “short leash” has new meaning to you and your best bud.
The bottom line is that while you may be a dog whisperer, your average “dog’s best friend” must put in a day full of “leavings” and “doings.” You have to get the kids off to school, shop at the grocery, stop at the dry cleaners, pop in to the bank, tire store, or pizzaria. So given the unique circumstances of your household, you will have to figure out the details surrounding your dog’s recovery. Time is critical. The healing process moves on without our explicit intervention.
Since the “plateau leveling” procedure causes any pain your dog experienced to go away, your best friend is again forced into a situation we have created.

Controlled activity is still a good two months away.

Pets At the Vets – Torn ACL – Part Three

18 Sep

While we waited for Casey’s surgery to be completed and for us to receive that critical “All’s well” phone call from the Vet’s offices, we poured through the TPLO and related literature. It was clear that the amount of use a dog puts on his or her knees was far in excess of what we applied to our own.

The Southern California Surgical Group stated that “Just as a car resting on a flat surface has no tendency to roll, in humans, the hip, knee, and ankle joints are parallel to each other.”  In dogs, the anatomic structure is quite different. Our four-legged friends stand on their toes. Their ankles are actually in the air, not firmly placed on the ground. Their knees are, unlike humans, “bent forward.”

Thus the TPLO is required because the upper canine tibia slopes up. Any weight at all will move the previously aligned bone to slide forward. The upper tibia is sanded and reinforced with a steel plate and six screws to hold the bone in place to allow for healing. The bone-to-bone contact is exaggerated for best healing possibilities to take place. The now leveled tibia top totally eliminates the animal’s previous requirement for that pesky ACL. And herein lies the rub, so to speak.

Your Vet can only do so much. It is post surgery when your dog returns home that it is up to you, not your dog, to control the environment for maximal healing and wellness to take place.

For the first two weeks, Casey wore a “cone” over her head. She was not pleased. This once playfully obedient dog now had rules Our rules. Human rules. And we could not necessarily explain what had happened to her or why we had changed the rules. Without anthropomorphizing, it’s safe to say she knew something had happened. Her leg had these foreign metal sutures in them. She didn’t feel like her old self. And now she was wearing this “bonnet.” She was restricted to a relatively small area by a wall of exercise pen stretched over her bed, a water bowl, and assemblage of her toys, rugs, and a bone. That was known as “bed rest.” Total.
Whereas people could understand the concept of “no weight bearing” or “toe touching.” our best friends could not. So, their full and total recovery was now dependent on our committment (and ability) to restrict their movement so as to allow the bone to heal.



Pets At The Vets – ACL (Part Two)

18 Sep

The Tibial Plateau Leveling Osteotomy (TPLO) is the name of surgery performed on dogs to compensate for the fact that they have completely torn their ACL. As with humans, the ACL is a ligament. It does not grow back to full strength with rest. In fact, it does not return. Once torn, it must be repaired or it will heal as it would in the wild. The dog would have a limp or worse for the rest of its possibly shortened life span.
The literature from the vet stated that the rupture “of the cranial (anterior) cruciate ligament” if not repaired immediately resulted in “derangement changes” such as osteoarthritis in the stifle (aka “knee”) joint.
As if that were not bad enough, additional cartilage and related areas suffer (i.e. the meniscus), osteophyte growth known as bone spurs, and the joins of the other legs wearing out or blowing out prematurely due to excessive compensatory wear.
As Dr. Adam Galler states, “The TPLO has proven effective in returning” torn ACLs in dogs “to full function.” Also, he mentioned a comparative study recently completed in which numerous Labrador Retrievers had been followed post-TPLO, too. A full seventy percent of Labrador’s recovered.
“Our dogs are Golden’s,” I noted lamely myself, still stunned myself by the need for Casey’s sudden surgical requirement. Obviously, the size, bone structure, and genetics of the Labrador’s and Golden’s are similar. I started to think about the remaining thirty per cent. Why didn’t they make full recoveries? What happened along their their path to returned wellness that made the expensive TPLO not always a rousing success.
Now, I understand. And we’re only ten days post surgery. Soon you will know, too.


Pets At the Vets – The Torn Cruciate Ligament

18 Sep

When our three and one-half year old Golden Retriever returned from her afternoon play day with her sister, Maddie, we knew something was not quite right. At the park, they had been surrounded by best dog bud Dylan, pals Ziggie, Murphy, Jada, Jada’s six month old sister, Zolie, and the usual secret dog park romp. However Casey was favoring her right rear leg ever so slightly. We inspected. No touch or pressure sensitivity to the right rear leg or paw. By morning she seemed fine. She’s okay, we signed with relief.
Next play date, same thing. Within a few moments after returning home post park roughhousing with the buds, Casey ever so slightly favored her right hear paw. Again. So again we got down on the floor with her to inspect, palpate, move the joints, feel for burrs or stones between the pads of her paws. Nothing. By morning she exhibited no limp.
This went on for several weeks. Then without our seeing or even hearing any demonstrable event that signaled a totally torn cruciate ligament, she did not stop favoring the leg by morning… or afternoon… or evening.  In fact, she was not putting much weight on her right rear leg at all. Something was terribly wrong.
Our dog body-work guru came to work on our oldest boy, Felix, when she took one look at Casey’s limp and urged us to take her to the local veterinary surgical center for an evaluation. Wisely, she did not even want to touch Casey’s paw (as if Casey would have let her by then). Because our dog wellness guru, Bettina Lally, was so attuned to dogs, she recognized immediately and knew what had to be done.
Bottom line: Casey had torn her Anterior Cruciate Ligament (ACL) just as I had torn mine seven years earlier. What a small world, I thought. However I soon learned that a torn dog ACL is not as easy to repair. Unlike humans, I  read online, dog replacement ACLs did not take.
We wanted to make sure we found the best and most experienced orthopedic sugeon to give our gal the best chance for a full recovery to her previous self. After all, she had just completed her very first Blue Ribbon Agility Run and loved competing.  Since she loved the weave poles, a frames, teeter-totter, and cone runs, we hoped to be able to allow her once again to do what she so loved.
Thus we found the Southern California ACL “Go To” guy, Dr. Adam Gassel, DVM, of the Irvine Regional Animal Emergency Hospital, in Irvine, California. After x-rays, his diagnosis was serious.
Fully torn, it would require immediate surgery to repair if she were to have any hope of recovering to her former self.
Since we had anticipated this, we had refrained from allowing her food or liquids after midnight. Good thing.
While we left our girl in good hands, we were fully cognizant of all the many things that could go wrong during a general anesthesia procedure. She was to have what they called the TPLO for treatment of a ruptured cruciate ligament.#