TPLO Surgery and Recovery / Week 8—Great News!

I start this with absolutely fabulous news. We had our 8th week post-surgery visit with a radiograph. Bella was pronounced 90% healed and ready to resume normal activities. We have to e-a-s-e into it as she hasn't been doing anything for two months. (Food consumption has been cut as she's getting a bit pudgy with lack of exercise.) Swimming, highly recommended. Chasing balls, not very recommended, but if she is on a sit/stay at my side, I can toss it and release her when it's landed. Or, I can roll a ball to her. Oh Bella! She will be in heaven! BALLS!! She can hike. She can play with her buddies for 5 or 10 minutes.

The new rule is if she is tired and sore after limited exertion, lay off for a day or two. Administer carprofen and regroup. If she is good after limited play, I can do it the next day and up it by some matter of minutes. This is all fabulous, wonderful, extraordinary. I'd been told it was a six month process of slow, patient, structured re-introduction to exercise. And it is that. The vet said a solid six months to full healing, but Bella can move and resume most of ordinary life—and so can we.

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!

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:

• Pain Management 101
• How to Tell if Your Dog is in Pain

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!

TPLO Surgery and Recovery / First Five Days

I haven't written in years, but wanted to post about Bella's TPLO (Tibial Plateau Leveling Osteotomy) surgery and recovery as it is something I have been scouring the internet to learn about. I can only assume others are searching for information regarding their pup and what to expect of the recovery period. Hopefully this will help clarify some of what is in store for them and their favorite four-legged friend.

Signs of a CCL Tear

Bella had been noticeably, but intermittently, limping throughout the summer. Something with her back left leg was bothering her. I toke her to the vet in November for xrays, but they came back inconclusive--no swelling, no sign of arthritis. The vet thought is could be something with her back, but since it was intermittent, I chose to hold off on other tests. And really, after going through back surgery with our former dog, Lucy, I just couldn't face it yet with Bella.

By this June, however, her limping was continual. A second round of xrays showed inflammation and perhaps some arthritis. Although this type of technology won't shown a torn CCL, the indicators pointed in that direction. My vet, the wonderful Dr. Kate Schottman at Sunset Pet Hospital, recommended I go for a consultation with Dr. Jennifer Weh at Blue Pearl. Dr. Weh confirmed the diagnosis and within a few days, Bella was back for surgery. (I've been asked why an MRI wasn't performed. Dr. Weh said they are prohibitively expensive and also, inconclusive. Because they don't do many of them, not all veterinarian radiologists are adept at reading the results.)

The Surgery

No food after midnight and an early morning arrival at the hospital for Bella. For a Labrador Retriever, no food spells misery! Her surgery happened in the late afternoon; the hospital called both before she went in to surgery and after she came out. The surgery went sell and proved necessary as 70% of her CCL was torn. Thankfully, her meniscus was fine and there was little sign of arthritis. But this bring us to the rehab...

Luckily, as a dog owner, you are never fully cognizant of what you're in for with TPLO surgery. You can read and read about it, but until you live it, you just don't know what you will experience with your dog. I don't need to explain the surgery as you can read about it on your own and your vet may recommend something else. In our case, Dr. Weh said it is one of the most common orthopedic surgeries performed on dogs and has an excellent success rate. As an owner, I was concerned Bella's predicament was caused by something we did, or did not do, but Dr. Weh said it didn't matter what the dog's age, athletic ability, gender or weight. A small peace of mind.

Initial Recovery

The first three days were brutal. Bella was anxious wearing a cone, anxious being sequestered and obviously in a lot of pain. Whimpering, lip-licking, drooling, yawning... So sad to witness, but I kept (and keep) telling myself the outcome will be so worth it.

The vet tech was adamant we follow the protocols and because it's our girl (and the surgery isn't cheap), we're on board. Some things I've modified, but not the big stuff.

 

Drugs

Bella is on the following drugs:

• 100 mg Carprofen / once a day (anti-inflammatory)
• 750 mg  Cephlaxin / twice a day for seven days (antibiotic)
• 30 mg Codeine / every eight house (pain relief)

I kept on a strict pain management schedule they had begun at the hospital: 4AM, Noon, 8PM. They said in three to four days I could try tapering the codeine to two pills every 12 hours. Today (five days post surgery) is the first time I will attempt codeine only twice daily. It will depend on how she feels later this afternoon whether this is successful. What they warned me is it is much more difficult to get her comfortable again if she's off the regiment, so I need to be mindful of her and not force the issue.

 

Feeding

Bella loves to eat. Getting food in her and pills down her has not been an issue with the exception of the codeine. I can't disguise it. I tried putting it in a ripe blueberry. Nope. Ripe cherry. Nope. The tech said not to use fatty things like cheese or peanut butter as it would slow the absorption, so I resorted to Pill Pockets (chicken flavor, thank you very much) and that did it.

I also have stuffed and frozen Kongs with her meals (which I cut in size by about one-third). This gives her more to do throughout the day as she gets bored. And what a bonus! Five meals a day!

One of the odd things that has occurred is her disinterest in water. Normally, she is quite the drinker. With pain killers and no water intake, I knew her ability to defecate was going to be seriously compromised, not to mention the concern of dehydration (by Day 3, her gums were sticky--a sign of dehydration). So I've added some canned pumpkin (no seasoning, just squash) to water-soaked kibbles to help with fiber and water intake. I am also "lacing" her water with homemade, unsalted chicken broth. Boy! She's cleaning the bowl! I'm running out of the homemade variety and will have to use commercial, low-sodium canned broth, so a little more water, a little less broth. Hopefully, soon, I can just be giving her unadulterated water. Is it the drugs? Not sure. Another question for the surgeon or vet tech.

 

Crating and Cone

Unfortunately, she has to wear the Cone of Shame. What dog likes that! I debated whether to purchase an inflatable collar, but Bella is a long-bodied girl and I know she'd still be able to lick her leg. Luckily, she's very obliging and does not fight wearing a cone. She doesn't like it, but she doesn't avoid sticking her head inside of it--and by Day 5, she is "comfortable" sleeping with it on. Luckily it will only be for two weeks until her next appointment. If, when we go in for a recheck and all looks well, her stitches will be removed and the cone dispensed!

Comfortably sleeping in her kitchen corner.

They recommended crating her, but we don't have one, so I've cordoned off part of our kitchen. It is an area where she already has a bed, so I knew she'd be comfortable with the area. It's also big enough that I could put a small chair within the boundaries and be with her. I swapped out her lumpy bed (I was concerned about her stability on it) for some memory foam. She wouldn't get on the foam prior to this, but seems to love it now.

As I mentioned the first three days home were awful. I ended up sleeping on the floor of the kitchen next to her and it helped both of us. I could monitor her closely and she didn't feel abandoned. It also helped that my husband was gone so I could devote 100% of my attention to Bella. During those three days, the codeine would wear off about an hour before her next pill was due and that made it difficult. I didn't want to mess with the timing of the pills, but I was anguishing over her pain and discomfort.

We're now at her fifth day home and there's incredible improvement. I noticed progress yesterday afternoon and today she seems remarkably better. Most importantly, she is able to sleep.

I bought an x-pen for her for the yard and a harness to help support her while walking, but don't feel I need either, so back they go. She'll be fine on a long line and has managed our two stairs to the back yard since the first day.

Last night we moved her bed into our bedroom and she slept through most of the night and I got to be in a real bed! She got up around 1AM and was restless enough that I took her outside to no avail. She was more quiet when we returned though. I am hoping tonight she'll sleep through the night.

 

Walking and Exercise

From the get-go, they wanted her to do limited weight bearing. I am allowed to walk her slowly (to get her using all four legs) for 5-10 minutes four times a day. Bella is putting weight on her leg. I doubt it's full weight, but she is using that leg. Initially five minutes was about all she could do, but she wants to do more than ten minutes now, although I don't allow that. As she won't defecate in the yard, I've been taking her up and down the alley. She'll only go once a day, but she isn't straining.

Bella's red ankle.

The first two days, her ankle below the incision was swollen and brilliant red. Quite shocking. The red was probably razor burn, because it's fine now. They had warned about possible edema around the ankle and recommended some gentle massage to increase circulation. Her ankle was bloated and fleshy initially, but looks normal today.

They also recommended I do ten seconds of passive range of motion exercises with her leg three times a day. It's a basic bicycling motion. She didn't fight it, but I could tell she wasn't keen on it either. After talking to the tech, they said if she was standing and walking on the leg, that should be plenty, so I'm leaving it at that with just an occasional cycle movement.

Interestingly enough, she seems not at all bothered by sleeping on that leg. She's even used it to scratch her neck when the cone comes off!

 

Care of the Incision

Not unlike care of our wounds, they told me to ice her leg for ten minutes every six hours the first three days. This must have felt really good, because Bella didn't budge when I did this. I used frozen corn wrapped in a light towel. Sometimes I put it between her legs and other times on top of her injured leg.

Incision, Day 5.

By Day 4, the hospital instructions urged switching to heat rather than cold. I warm a wash cloth under hot water and bag it. I lay this directly on her leg. I use my husband as 'Heat Controller' as he is much more sensitive to hot than I am. On me, it feels pleasantly warm, however, Bella doesn't seem to like the heat and will move her leg away from it. Too hot for her? Unsure, as a bit cooler doesn't seem to work either.

Obviously she is not to lick the wound which of course she really wants to do. Hence the cone. Periodically when I am with her, I do remove it and I can tell she really likes that, but any sign of licking I slip it back on. However, without the cone on, I do allow her to clean her crotch, an important ritual for her.

The surgeon would never qualify as a plastic surgeon. The incision will end up a scar, so I will check with them about massaging the area to break up scar tissue. I don't really care what it looks like (nor does Bella), but I think lack of scar tissue will allow better movement in the area. The incision, itself, looks clean. No weeping or smell.

Happy Thanksgiving!

Happy to be in the wood, by a lake, with her human pack. Happy Thanksgiving to you!

Poisonous Mushrooms

Part of the backyard stash.

This has been a fantastic year for mushrooms in the Pacific Northwest. Hiking has been wonderful for all the varieties one can see and if you're knowledgeable, great for picking and eating. However, while 'shrooms can kill you if you ingest the wrong variety, they can likewise poison your dog. I was at a recent pet first aid class put on by our local emergency vet hospital, ACCES. The vet tech conducting the class said they have seen a large influx of dogs poisoned from eating mushrooms. 

A local TV station recently posted this article which has some great links at the bottom. Please read the article and check your yard for mushrooms, protect your dog. I removed a large bowl from mine.

First Snow of the Season

Bella feels strongly about the snow.

Our camping trip into Colorado was fun, but cold! In fact, the snow turned us around as we just couldn't stay warm. Bella, however, had a ball!