July 24, 2018

TPLO Surgery and Recovery / Week 4

We just completed our four-week checkup and Bella came through with flying colors. Yes, she's still in the early phases of healing, but she is moving appropriately for that. Her leg is still jittery and her sits sloppy, but that is normal. The following are my questions to the vet and her answers.

Jittery Leg
The trembling is caused by Bella not putting full weight on the leg. It could also be a bit of excitement (as in going for a walk). If it is jittery while walking, that means she's tired and that means the walk is too long.

Wobbly Gait
The vet did not notice anything odd about Bella's gait. That knee is a bit larger (though it isn't swollen) than the other knee, so perhaps I am over-analyzing her movements. Vet said it should not be a concern.

Sloppy Sitting
Enjoying a Kong, post vet visit.
I am not at all perturbed about the "confirmation" aspect of Bella's sitting, but more about the stiffness and usability of her leg. When she sits, the TPLO leg is more to the outside and straighter, as if a tight bend were not comfortable. The vet said I can start correcting that by pushing her knee closer to her body. If Bella resists, she said stop the corrections. It's a bit early yet anyway, but she said it would be good to work on "sits to stands" which requires the leg to be folded near her body. I will add this to her "figure 8's" in walking where she has to weight the leg differently depending on whether she is turning to the outside or inside of the "8".

Stairs
Because Bella is long-legged, stairs are okay. We just need to watch that she doesn't race up or down them...which she does. The vet recommended holding on to her collar to keep her at a slower pace.

Walks
I asked if it was possible to give Bell two 30-minute walks daily rather than four 15-minute walks. The vet okayed that, but urged caution. She said shorter remains better for the healing. As it is, it is so hot here, that the half-hour walk is only in the morning. Bella gets a backyard pee break mid day and a short evening walk. The vet also said to keep at this pace until our eight week check up. So 20-30 minute walks R Us.

Play Time
Bella still cannot play with her buddies. She's going to be really excited in September when that ban is lifted! All in all, it's a six month healing time.

Swimming
If I can control Bell's entrance and exit from the water, the vet encouraged me to take her swimming. It's good movement without the bone stress.

Camping
We are hoping to go camping next week and got the okay to do so. Bellie cannot go mountain biking or running yet, but I can take her on her timed walks/hikes. We all need to get out of town, so this will be (hopefully) a wonderful adventure.

TPLO on the Other Leg
Those of you reading this or researching this surgery already know the statistics: 50% of dogs have the same surgery performed on their other back leg within a year. It is not from over-use of that leg during the healing process, but just plain, old genetics. I am so hoping Bella beats the odds!

July 10, 2018

TPLO Surgery and Recovery / Days 6-10

Day 6

The codeine tapering did not work initially, so I went back to giving it to Bella 3 X day, but with only five days left, tapering will begin again. I was told at the end of her prescription, I could stop cold turkey, but it seems more kind to taper it.

I looked up information on pain management for dogs (and cats) and came across many good articles. Here are two:

Day 7-9

Drugs

After giving her two more days on full dose, I dropped her codeine to twice daily and it worked well. She is more alert (was that the drugs?), but not necessarily more active. By day 9 and 10, I dropped her to 1 tab a daily, divided morning and evening. She has also begun drinking plain, undoctored water on her own again. (Anesthesia? Drugs? Not sure what precipitated that dislike.)

I have taken her cone off during the day while I'm with her. I still watch her closely, but she is not as urgent about licking and is good about stopping. Her movements are more sure, though if she hurries, she doesn't use her leg. It remains essential to keep her on a leash in order to slow her down, which requires use of that back leg.

July 4th, Independence Day for Americans, has never been a good day for any of our dogs, and Bella is no exception. Of course the firecracker folks start days early and finish several days afterwards. Any explosion is miserable for her, but on the 4th proper, the bangs began around noon and lasted until 2AM the morning of the 5th. Bella was absolutely a jumble of nerves.

The vet had given me some acepromazine/25 mg (tranquilizer) to give her if necessary, recommending I begin with 1/2 pill. I was hesitant to use it in conjunction with her codeine, but I was assured it would be okay. As the evening wore on, and the explosions intensified, it became obvious that is was necessary. Bella was in full body shakes and drooling; I did not want her moving and restless all night. I chose to give her a 1/4 of a tablet, figuring she already had codeine in her system. My husband downloaded some "white noise" and with the drugs and staying in the basement with us, she was able to make it through the night. I had her cordoned off, in her cone, in a small space. I used to love the fireworks, but now with dogs and knowing how some veterans suffer through it with PTSD, I have little sympathy for the noise.

Movements

Bella has been moving around more. Getting her to the basement for the 4th of July, required taking her outside, around the house and a series of stairs: 2, 2 and 5. I was concerned for the number, though they were separated, and concerned because fear was urging her to bolt. I had to hold her with two hands on a short leash.

In the morning, letting her out of confinement--unleashed, she made a dash (really? yes, really!) for the stairs inside our house (of which there are 16). She got up about 5 when I was able to stop her, but she spun around and ran back down. I am hoping she is okay. All of those movements are big No-No's. She isn't favoring her leg any more than usual, however, which I'm taking as a good indicator.

She is much more eager on walks and really wants to range, which she isn't supposed to do yet. I feel badly in the sense that I know she's loving being outside and smelling. What I'm noticing is she is faster now, nine days post surgery than she was prior to her operation. Her leg must have really been hurting.

Day 10

This was our day of reckoning. All her drugs are finished. I let her sleep last night without her cone. This morning we saw the vet for stitch removal. The prognosis? Yahoo!! The vet thought she was doing really well; her wound looked great.

Our list of what we can now do:
  1. Not wear a cone. Happy dance!
  2. Up the length of walks to 15 minutes four times a day on any terrain.
  3. Work on walking long figure 8's to get her to use and balance on that leg.
  4. Work on stands from sitting. (She's already doing this.)
What we still cannot do:
Day 10 Coneless, stitchless and free to move about the cabin.
  1. Limit stairs.
  2. No playing with her dog pals.
  3. No swimming.
  4. No jumping.
 A pretty good list if you ask me. Bella will be really happy with the longer walks (as will I)! She has another appointment in two weeks for another checkup, but the vet said if her progress is maintaining, we can cancel it. Then in six weeks, the end of August, we go is for xrays to see how the bone is actually healing.



A foot note. Bella was given Dasquin and carprofen for her pain and joints several weeks prior to this surgery. I asked Dr. Weh, the surgical vet, about continuing them. She said the Dasquin was fine to continue, but recommended I stop the carprofen as it has been shown to interfere with bone growth (yikes!). Also, Bella's knee showed no signs of swelling (yay!), so she felt it unnecessary. So carprofen is stopped as of today, though she said if Bella seemed stiff or in discomfort, it was fine to give it to her for a day or two. I think with supervision of her activities, she should be fine.

On to the next two weeks of recovery!