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An ACL tear and TPLO journal


Sue R
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Thank you for your thoughtful and very appropriate comments! You are correct in that some people either don't have access to a therapist and, quite frankly, some people are not in a position to afford the cost of a therapist, and I understand both of those positions.

 

What I am trying to do with my remarks about using a professional therapist is this. I want to share my experiences (like people do on Orthodogs) but also sharing photos and videos so that people (including myself) can see as well as read about this surgery and rehab. I don't want people to look at this as the basis for their own rehab - I'm not a vet, vet tech, or therapist, and am in no position to offer any form of medical/therapy advice, but I can share my experiences.

 

This "journal" is helping me - I can consolidate thoughts, be able to look at photos, keep track of schedules and programs (and setbacks, too), be reminded of things I might otherwise forgot to do or look for, and be able to review Celt's progress. And I hope it will help others who may find themselves facing a similar situation - being able to see in some detail what might lie ahead for them and their dog, being encouraging to and supportive of them, and providing some visual aids to help them (as it has helped me) in seeing how certain exercises look when properly done and some things to look for as their dog progresses in his/her recovery.

 

I sure hope that your dog may make a full and uneventful recovery from here on out, and sympathize with your concerns. This is not easy even when everything seems to be going right, and it is a very anxiety-provoking situation to have things not going smoothly and in the direction you want them to go.

 

Very best wishes to you both!

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Yep I am doing similar re my experiences on my young girls blog and I do agree with the writing things down and keeping track of things for your own record.

 

As for my youngster - consideration is still very much whether the specialist will go back in and do more in another 4 weeks. Agony as you might appreciate its not particularly easy keeping a BC "rested". Oh well we will face that battle if we come to it.

 

Good luck and all the best with the remainder of Celt's recovery :).

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August 18 2012 - almost two months to the day since surgery, and the end of six weeks of therapy

 

I found this week’s therapy visit to be very enlightening. It was again brought home to me that for me at least, if I can have a professional therapist help in the rehab process, it’s very worthwhile because he/she knows so much more about physical therapy and can see so much that’s happening (or not happening) than myself.

 

This past week, Celt and I did run into some minor issues. Try as I might, I could not do the cross-legged exercise with him. I just could not get it right and rather than risk hurting him or setting back his progress, I dropped that exercise and just substituted more three-legged dog exercises like we were doing previously.

 

And, since he seemed a bit stronger than the week before, I began doing two sets of stairs (about 10 steps) with him after each walk, which meant about three times each day. He was doing those very nicely as long as I made sure to control his rate of speed. If I didn’t and he went too fast, he would hop. The slower I could make him go, the better the exercise would be done.

 

Shari liked what she saw when she observed Celt just walking or trotting around the rehab room. She did his cold laser and ROM exercises, and all seemed well there.

 

She measured his thigh circumferences for the third time. Six weeks ago, she measured them at his first visit, and there was a difference of 4 cm between the two, with the “bad” leg being the smaller one as it was atrophied a bit. So when she measured his legs after three weeks of exercise and therapy, she fully expected that difference to be reduced. To our surprise, it had increased to 5 cm.

 

We both experienced a few moments of wonder and concern at why this was so, and dismay that he was not progressing like he seemed he should be doing. But then I suggested that since he had been on crate rest/reduced activity for quite some time (since April) prior to his surgery and subsequent visits to her, that maybe both legs had atrophied to some extent and the sound leg was simply recovering more quickly than the injured leg. That made great sense to her and we were both quite interested in re-measuring again in another three weeks to see if the numbers had improved.

 

And so they had – she was very pleased to report that this week’s measurement (after another three week interval) was 3.1 cm difference. That was very welcome news!

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I weighed Celt again this week. Like last week, he had lost one-half pound, so he has lost an average of one-half pound per week since beginning his therapy exercises. Now down to 44 pounds, Shari and I both agreed that he didn’t need to be losing any more, particularly since one of our goals is building muscle, and so I am increasing his food just a bit to offset the increasing activity and provide nutrition for muscle-building.

 

His foot pad and toenail wear is looking good – much more symmetrical wear patterns on the pads and more even wear on the nails indicate much better and more even use of his hind limbs.

 

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While Shari did do the cross-legged exercise with Celt rather than the three-legged dog, she agreed that I should continue with the three-legged and leave the cross-legged to her for now.

 

Celt did really well on his stair exercises and I am able to substitute some stair work for other, more time-consuming work if I find myself hard-pressed for time, but no more than five sets of stairs at a time. Right now, we are doing two, three times a day, most days. But, again, I was grateful for Shari’s professional eye as after Celt did the stairs there (only four steps) twice very nicely, he “hopped” on the last one. I thought he was just being silly and getting excited and would have gone on thinking that if Shari hadn’t been watching closely and said that no, she had seen that he was tiring and that’s why he had hopped.

 

She also pointed out that going down the stairs is much more difficult and strenuous than going up the stairs, because of the way the muscles in the hind leg must function to control the downward motion. One symptom of stifle joint problems is discomfort at moving downward on a slope (or stairs).

 

But she also pointed out that the exercises that we do at home are more compressed at a visit, what she does is more challenging to the dog and pushing his limits, and there’s a certain level of mental stress as well going on, and most dogs may tire more quickly at a therapy session than they would at an at-home session.

 

He did well on his walking backwards exercise but he’s never been a dog that liked walking backwards and his stride back, while improved, is still pretty short. Again, Shari reminded me that I need to make sure we do this in straight lines, so that he is not favoring his bad leg but making it work as much as the good leg. So I use his cavaletti pole and cones to make an alleyway along the couch so that he has to walk back straight. That improves the value of the exercise and makes it much easier for me to get a straight line from him.

 

He did really well on the cavaletti but he showed us both that he is still not ready for a 10” height. He is doing 9” at home (I have the cones set up on books to get this intermediate height) easily and well.

 

His sit/stand exercise is fine. I’m not seeing any noticeable improvement but since we do this exercise last, when he is tired, it may be a while before we can really see much improvement. And, as Shari pointed out, the angle of the stifle has been changed by the surgery, and so this may never be quite symmetrical.

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And on to the treadmill, always Celt’s favorite part of the visit. Shari pointed out (and I had noticed) that he was starting off nice and straight in each of his 3 ½ minute (another 15 seconds added to each) treadmill sessions. Then he would start to “weave” a bit. I thought that maybe he needed the speed increased again (Shari did that several weeks ago when he started hitting the stationary front bar with his toes) but she pointed out that weaving is not an indicator of the treadmill not moving fast enough for him.

 

She could see in the mirror that while his stride started out straight and strong, he started to weaken for a bit – as he weakened, he would place each hind leg more centrally under his body to better bear his weight. Then when he stepped, he would tend to bring his weaker hind leg further under his body, and that would cause him to track more towards his left.

 

When a dog deliberately changes direction, he turns or moves his head in the direction he wants to go and the body follows. So if I move to one side of the tank, Celt turns his head to watch me, and his whole body tends to follow his head in that direction. In Celt’s case in this instance (when I was right in front of him), his weaker, right hind leg was moving too far to the left as he brought it under the body, then his stronger, left hind leg would have to move left to go “around” the right hind leg, and so his hind end was “leading” his body towards the left (with the front end “following” the hind end to the left). Then he would move back towards the right in correcting the leftward weave.

 

He would do this for some short time, maybe 10 or 15 seconds, regain his stronger stride and straighten out. We noticed this most in his first session, and less in the next two, perhaps as he adjusted his stride to the effort that the treadmill requires compared to dry land walking.

 

I asked Shari about how to “translate” the walking in the treadmill to walking on dry land, trying to get a feel for what treadmill walking equates to in dry land walking. She said that the setting he was on now (and for the last few weeks) was just over a mile per hour (speed equivalent, not effort equivalent). I wondered why it wasn’t set much faster than that – when I walk hard, I can walk at about a four mile per hour pace. And then the lightbulb went on as she told me that at that rate, the dog would no longer be walking but would have to trot to keep up. And that explains why in our walks at home, I was rather surprised (and disappointed) to figure out that we were only covering about 7200’ per hour of our dog walks, or about a mile and a quarter per hour, which seemed like so little. But that’s the rate I have to walk with him to keep him at a walk.

 

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Of course, walking for a minute in the water requires much more exertion than walking a the same pace for a minute on dry land. And I forgot to ask her then what she thought that one minute in the treadmill would equate to on dry land. That question will have to wait for the next visit.

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So, the routine for the next week and a half (until we see Shari again) will be –

 

Two 25-minute walks and one 10 minute walk, each followed with 2 (up to a maximum of five) sets of stairs;

 

Six reps of ROM on each leg;

 

Ten reps of three-legged dog on each leg;

 

About 15’ of backwards walking;

 

A dozen steps over the 9” cavaletti;

 

Six reps of the sit/down exercise.

 

But this time, Shari said I could be flexible since Celt is showing good use of his leg (as evidenced not only by his work but also by his footpad and toenail wear and by his thigh measurements) – so, since it’s the busiest time of year at work and I am working some extra days and time per day (and being on my feet and very actively pressed each day with physical work), I can vary the routine a bit to fit my time available and how I feel.

 

She has often said, “You know your dog best, Sue” and so I need to be observant and make sure that if he can’t do something, I substitute something he can do – but without opting for just doing easy stuff at the expense of not challenging his body to develop and improve in strength, balance, and stamina. So it’s a game of doing enough but not too much to continue to make progress.

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August 25 2012 - almost 10 weeks post-op and seven weeks of therapy

 

And we hit the dreaded “s” word – setback!

 

I had gotten the go-ahead from Shari (who has simply too much confidence in me) to vary the routine if I felt I needed it this week. This week, the first week of classes at the university, is the most difficult, exhausting week of my entire work year. I spend extra days, extra hours, extra effort, extra emotion, extra frustration – extra everything – and become wiped out physically, mentally, and emotionally, as well as sore and achy as can be. So, I asked if I could vary things if I was either short of time or short of physical ability (or gumption) to do the usual.

 

Since Celt has done so well, and has really been ahead of the curve all along, Shari said I could but I pretty much did the usual most of the week. Then I hit Thursday morning, or felt like I’d hit a brick wall (even though I was fresh out of bed, and had been taking Advil on a somewhat regular basis), so I did the 25-minute walk with the dogs and, instead of doing the ROM, three-legged, backward, cavaletti, and sit/downs, I just did five down-and-ups on the basement stairs.

 

Shari had said I could increase the stairs as Celt seemed ready to do them, going to three reps (which I’d done before Thursday) and a maximum of five. So, pressed for time and ambition, that’s what I did Thursday morning. When I walked Celt on Thursday evening, I thought I detected just the very slightest hint of lameness – nothing that I could see in his gait at the walk or occasional few trot steps he might take, but a tiny bob of the head when his right (bad) leg was moving forward.

 

On a horse, an uneven head bob is usually indicative of lameness, and I was watching him like a hawk because I thought I could see the head bob just a tiny bit more when that leg was moving forward than when the left leg was moving forward. We came home and I decided to not do the stairs but did the ROM, skipped the three-legged, and did the other, easier exercises.

 

Additionally, coming back down the road (which is very eroded and uneven pavement with loose gravel scattered about), I turned my ankle and went down in a heap. Fortunately, I was near the edge of the road (and not the side with poison ivy) when I fell, with both Celt and Megan on lead – because I saw the lights of a pickup truck coming over the hill in our direction. I got Dan to me and we all sat at the edge of the road (the driver stopped a bit past me, got out to see if all was okay, and said he’d initially thought I was just holding the dogs for him to pass until he realized it wasn’t normal for me to be *sitting* there in the road to do that.

 

Did I fall into Celt? Did I kick or hit his leg? Did I cause him to twist or jar it? Did I yank the leash? I don’t know. It all happened so fast and I was concentrating on trying to not hurt myself going down that I don’t recall anything about the dogs.

 

Friday morning, he was noticeably limping – not a “lot” but visibly. What really let me know he was hurting in some way was when he peed – that leg is his preferred stand-on leg to pee and he would approach his spot, get ready to lift his left leg, and then turn around to lift the right leg. That told me something was not feeling good. So I just walked him a shorter walk, no stairs, did ROM, and skipped the other exercises. I was quite distraught – I’d taken a shortcut, and Celt was paying the price, and I had no idea how much my mistake was hurting him.

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Right after work, I got a call into Shari who calmed me (bless her heart) by saying what friends had already said on FB – that we just “over-did it” and he would probably be fine in just a few days. She reminded me that it’s easy enough for a person to overdo (especially appropriate with regards to work this last week as I know I was really pushing myself hard, and feeling it – Tuesday evening, I had to take my shoes off in the car as Ed drove us home, and put my rapidly swelling feet up on the dash because they were painful in the shoes once I’d stopped walking – and, if it hadn’t been for Advil, well, let’s just not go there…).

 

She suggested I get some Rimadyl from his regular vet (bless their hearts, they did approve that even though for the surgery and rehab, he is not their patient) for a combination of pain relief and (as importantly) its anti-inflammatory effects. Plus, I am to cut back his activity – two or three walks of no more than 15 minutes each and just the ROM twice a day, plus the Rimadyl. And call her back on Monday evening.

 

The effect of the Rimadyl was obvious – within an hour or two of his first dose, he was feeling much better and I have to be very careful to restrain him because he thinks he can conquer the world right now. And, with his increased energy due to his walks and exercise, he is feeling that this cutback in activity is not suiting him very well. Fortunately, he’s easy to work with and not fighting it.

 

Lessons for Sue – follow instructions, don’t overdo, don’t think that because the dog *looks* and thinks he’s ready that he *is* ready for a suddenly-increased challenge, and don’t get carried away by feeling that your dog is achieving at a rapid rate and can be pushed harder than he should be. The “easy” exercises can be increased without much worry – the ones that pose a challenge (like stairs, probably the most difficult, stressful, and demanding exercise he is doing) need to be increase carefully and only when he’s ready.

 

Celt needs to be challenged – he would not be making progress if he was not being challenged physically, to increase strength, flexibility, and stamina – but he needs to be challenged with increasing levels as he is ready for them, and not with sudden spurts that might overdo things.

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Meanwhile, I read an interesting article about ACL tears and early spay/neuter that had been linked on Orthodogs. There is a vet who does a blog called www.angryvet.com and who appears to have some articles of interest to dog owners. Now, I have only ready one or two so I can’t really offer an informed opinion, but he has written an entry concerning his own personal observations of what he feels is a relationship between ACL tears and early spay/neuter.

 

Compiling data from his own patients, he found the incidence of ACL tears in intact animals to be 1/7 the incidence of ACL tears in those animals that were spay/neutered at six months of age or younger. To make a long story short, dogs that are neutered early tend to have longer leg bones, narrower frames, and other skeletal-based physical differences. Here is a quote from his page concerning a study done with Golden Retrievers:

 

“This delay of growth plate closure can result in different angles from one set of long bones to another. For example, a study by Dr. Kathy Linn and her resident Dr. Felix Duerr showed that spayed and female animals have a significantly greater tibial plateau angle. This is because the tibial growth plate stays open longer then it is supposed to and the tibia continues to grow longer relative to the femur in “fixed” animals as opposed to those animals who are intact. It is widely known and accepted that animals with a greater tibial plateau angle are at a much higher risk for anterior cruciate injury.”

 

Celt was neutered at six months of age (with both Bute and Dan, I waited until 18 months). Is this a reason? Most of the working Border Collies I am aware of that have torn their ACL did so by accident – running into an obstruction like a short post in the ground and so it was a tear caused by a sudden, unusual traumatic event. Much of the working Border Collie community does not do any form of early spay/neuter as most owners/handlers/breeders want to see how a dog or bitch shapes up as a stockdog before even considering keeping the animal intact or neutering.

 

I find this blog and this study to be very thought-provoking. I also wonder if it has any bearing on something Dr Payne (Celt’s orthopedic surgeon) said – he said that in his thirty years as a canine orthopedic surgeon he has noticed that while the vast majority of his patients in earlier years were smaller dogs, the majority now is larger dogs. I wonder how much this might be a reflection of the fact that more and more responsible pet owners are spaying/neutering their dogs and at a relatively young age; that pediatric spay/neuter is common among rescue/shelter adopted young animals; that more people participate in dog sports and strenuous activities with their animals (putting them at risk for wear-and-tear tears as well as traumatic tears); and that more people are likely to take their dogs to the vet for “a limp” and pursue surgical options for repairs (in my younger days, we’d have probably said the dog hurt his/her leg and thought there was nothing that could be done for it, or certainly could not have afforded the kind of surgery/therapy that Celt is receiving if we had known such care existed); and that accurate diagnosis is more readily available (the first vet Celt saw did not even consider anything but a soft tissue injury but the second vet, with an interest in orthopedics, immediately suspected the ACL tear and did the draw test to confirm that).

 

Thought-provoking, perhaps? And another good reason to spay/neuter *after* the growth plates are closed.

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That's pretty interesting. Our vet has said that spaying early can prevent a lot of types of mammary cancers but holding off can help prevent osteo issues. They feel that the benefits of spaying early outweigh the benefits of waiting. Tiga was neutered early and he tore his ACL when he was 6. His was also accidental, running in the yard after a long winter, turned and slipped on the slippery grass hill and bam, torn ACL and meniscus. I'm hoping the same doesn't happen to Annie who was just spayed last Wednesday at 6 months. We can't afford (financially or mentally) to go through that again.

 

Also Sue, setbacks do happen. You've been doing so well with Celt and he will continue to improve. We had a lot more setbacks and "oops" moments for sure. But we also didn't have the option to do PT. There is no one here that does it and I don't think we could have afforded it even if it was an option. Keep up the good work and don't let this get you too discouraged. He'll bounce back again in no time. :)

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Sue - Celt is lucky that you are willing to do so much with him rehab-wise. Rehab is time consuming and setbacks always happen. Just think where he would be if you weren't taken the rehab seriously enough. You are doing a bang up job.

 

And remember: you may have another setback or a couple more and there is nothing wrong with that. You just take a small break and then start back up.

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One of my problems is that I internalize things way too much - a good day with a dog, and I'm happy. A bad day or a setback with a dog, and I'm despondent. I know that is me and I know that's my problem and issue.

 

Someone I respect once told me that, in my case where I was working with just one dog, investing a lot of emotion in the one animal (and therefore being very affected when things went one way or the other) is counter-productive but easily understood.

 

And so, when things don't go positively, I get very down about it. When they do, I am very up. A bit of polar, maybe?

 

Thank you both for your support! I am doing the rehab because I am fortunately able to afford it at this stage in life, and I truly want him to be able to resume the level of activity and work that he previously enjoyed, if that is possible. And I am able to make the time, although last week's pressures are what led to me working at the edge of the program and taking him a step too far.

 

Meanwhile, the Rimadyl makes it hard for me to see just how he is feeling but he is certainly still favoring the leg a bit, even though it's not readily noticeable - but I'm watching him closely and hard, and seeing evidence that he's not where he was before this happened. Without the Rimadyl, perhaps it would be very noticeable.

 

So we are walking twice a day, about 15 minutes, and when we can get in another go, another 10 minutes, and doing the ROM twice a day after the 15 minute walk. He's still loose in the house (Shari did not say to crate or xpen him) so he's got a level of freedom, and he seems pretty happy.

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You will watch him closely for a long time to come. I've only recently stopped obsessing over watching Tiga walk and it's been over 2 years since his surgery. I still watch but I'm much more relaxed finally. His first run off leash was nerve-racking for me but you really wouldn't be able to tell he'd done anything now. This is just a very minor setback. It happens, really don't be so hard on yourself. You said the vet said the bone was healed yes? That means your biggest risks are behind you. A few days of taking it easy and I'm sure he'll be right back where you were before. Tiga limped for a lot longer then Celt for sure but we didn't have the PT and it was a different surgery with a much longer recovery time. Someone put it in perspective for me when they said that when a human has the same injury, it usually takes about a year before things are back to normal. At only 10 weeks post surgery, I think you're both doing a fabulous job. :)

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Yes, the xrays showed the bone was well-healed and the surgeon said we didn't need to return unless there was a problem.

 

I am a worrier by nature - I've spent the last week with a gimpy knee, a small infection under a toenail, an aching back, sore fingers, and sore feet during a strenuous work week. And that hasn't worried me one bit but my dog having a minor limp during his rehab period - well, that's another story!

 

And I'm sure you know just how I feel! :P

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LOL! I sure do. I'm a worry wart by nature as well. I made so many phone calls to the vet the first few months after Tiga's surgery. I'm sure they're all sick of talking to me after 8 years, and now we have the puppy so twice the dogs means twice the phone calls. :rolleyes:

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LOL - hmmm worry wart comes with the territory. I am sure Kenz's specialist hides when I send another yet another email. Think he would like everything to be over with so he doesn't have to deal with my emails every few days or every week or so.

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I read a very sensible-sounding explanation today on Orthodogs that may have offered a reason why Celt's first ortho surgeon (three years prior to this year's surgery) suggested conservative management (CM) at that time rather than surgery. The comment was that when the joint was stable (which I would assume meant only minor damage), that CM was a possible treatment because rest (mild activity only) with medication would allow the joint to heal (and scar tissue to form). If the ortho vet examined Celt and found sufficient joint stability, she may have felt that his chances of recovering without surgery were good, and recommended the uninvasive, non-surgical alternative. In Celt's case at this point in time, additional damage (a complete tear) meant that the joint was no longer stable and would not recover with CM, and so surgery was indicated.

 

I guess I hadn't thought about it in this way. And, had Celt been a less-active dog (not working stock; not working on rough ground in all weather conditions, snow, mud, frozen ground, etc.; not an active ball-playing dog) who mainly got his exercise in leash walks and more sedate manners, perhaps that would have been enough for him to remain sound and avoid arthritic changes.

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Yep I am a worrier as well.

 

Riot has a shoulder issue. He injured it a few years back and he has flare ups a couple times a year. This last one was bad and he was put on crate rest for about 6 weeks, plus a steroid shot in his bicipital tendon. We have been swimming him as a rehab exercise per ortho instructions. He is no longer allowed to play disc. He is allowed to play flyball though. We actually rested him for more than 2 months (just crated for 6wks). He has always had a funny gait so trying to figure out whether he is favoring the shoulder is almost impossible unless the limp is severe. I swear I check his walk about 15 times a day and sometimes I think I see a limp and others times I don't. Riot is supposed to run at a tournament in mid-Sept for the first time since early May. I will be a wreck.

 

With Foster I kept an eagle eye on her legs since both were repaired. One little hitch and we were ready to drug and put her in a crate. It took a long time before we relaxed.

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That's just how I feel. I'm always watching for something to be wrong, and sometimes it all looks fine and sometimes I'm convinced I'm seeing something wrong. But then in the next second, it all looks right. I'm wondering if I am just looking too hard for something to be "off".

 

We'll see Shari tomorrow evening and she'll know what's happening. His last Rimadyl was this morning so he won't have that to mask any discomfort, and he's been on it five days, which is what she asked for in the first place.

 

PS - I didn't see anything to worry me during our walk just an hour ago but now, after Celt's had his ROM and been rested a while, I am definitely seeing him favor that leg. I expect since his last Rimadyl was this morning, the effects are wearing off. I am not happy but we'll just have to deal with whatever's the issue.

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Its so hard 2 Devils - Kenz also has had shoulder issues and the only reason we discovered the patella luxation is when she was forced to rest for the shoulder and lost a lot of muscle support.

 

Kenz's specialist has said he doesn't want to see her back if things remain as they are. Her chiro vet has suggested acupuncture if she is still stiff and sore and we aren't making progress but gah I don't know what progress is these days. She hasn't had a 3 legging episode in a fortnight but the stiff and sore isn't changing and I can't see it improving anytime soon.

 

Complicated and frustrated.

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Have you tried her on glucosamine? We have Tiga on Osteosupport which we get at the vet and what an improvement since he's been on it. It works much better then the regular glucosamine that we did have him on. It's in a capsule and I just sprinkle it on his breakfast in the morning. It works so well that we recommended it to a friend with a rottie/husky cross who's having arthritis issues and he saw a different almost immediately.

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Is it the osteosupport? We noticed a huge difference between the regular glucosamine and the osteosupport. We started on the glucosamine that you can get at the drug store and didn't see much improvement. Our vet then started carrying the osteosupport and they've had a lot of success stories with it. I don't know exactly what the difference is between them but it's like night and day. I'm so sorry you're going through that with her. I hope she improves.

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Joint guard is the one I am using (I am in Australia) - http://www.jointguard.com.au/

 

Her chiro vet has said just be patient (I don't have much left these days) - his view is it could take 3-6 months for her to be back to normal. The specialist did say 6 months as well. Kenz is just on 4 months post-surgery.

 

Ah well in the meantime we head back to the pool today for some more swimming.

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