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An ACL tear and TPLO journal


Sue R
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Sorry to hear you are having issues with healing and progress.

 

My caveat of the week, again, is "DON'T OVERDO". After having Celt on Rimadyl and reduced activity for five days, I took him off the Rimadyl with yesterday morning being the last dose, so that when he went to see Shari this evening, he would not be affected by the Rimadyl so that she could truly evaluate his status.

 

And, since he was feeling so good, and because Megan went woodchuck hunting in the neighbors' yard, he wound up having a 25-minute walk both morning and evening. And, unbeknownst to me until after, Ed took him on a pasture walk with the other dogs. He was on leash but that was his first pasture walk of any consequence since well before his surgery.

 

Stopping the painkiller/anti-inflammatory, coupled with way too much exercise (I should have kept him to a total of no more than 30-40 minutes of walks a day, with no walk over 15 minutes), and guess whose dog was very sore this evening? He was worse than he was last week, hardly putting any weight on the bad leg. Toe-touching, barely-touching, and not wanting to stand on it to pee.

 

So I called Shari, who rightfully chewed me out for exceeding the exercise limits she'd set, that along with the Rimadyl, would have helped him stay limber but give the leg a rest and a chance for what seems to be a soft tissue injury to heal. I let his feel-good, feel-strong attitude (powered by a combination of his Border Collie nature and the Rimadyl) lull me into thinking he was better and ready for more exercise.

 

His appointment had to be postponed until Saturday due to my car being in the shop, and so he's back on the Rimadyl, and not to be walked any more than in the yard to do his business. And for this evening, he is confined to the xpen to avoid over-exhuberance in the house.

 

Maybe someone should confine me to an xpen...

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Yeah I wonder if she is possibly overdoing things but by the same token I was told conservative wasn't necessary anymore. Having said that she never had bone cut with her procedure so should have had a much shorter expected recovery time and much less restricted activity then she ended up having.

 

What we have at this stage is more general soreness and stiffness in through her back rather than specific to her surgery leg. She has managed a full fortnight with no 3 legging and the specialist is happy to not see her again at this stage unless I think its warranted.

 

He has said to play it careful for another couple of weeks with no forced jumping or retrieving or tug.

 

Sorry to hijack your thread Sue R. I do have a semi-related question - you have Celt doing cavaletti's I have it suggested by a close friend here who has a canine rehab background that it would be worth doing some thing similar with Kenz. The issue I am having with those is her agility background means she sees something resembling a jump and gets extra wound up and won't walk over them properly. Did you have any issues with your boy in having him actually walk over the jumps? How did you start out?

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Yes, normally we do cavaletti twice a day but, along with almost everything else, that's suspended temporarily.

 

Celt has done some agility but only in a very small way so his first reaction to the cavaletti was to pop over. But we've also been working (a lot!) on the command, "We're walking". We used a lower cavaletti to begin with, he was on a short lead, and I told him we were walking. When he pops (usually primarily with his hind end) I will say, "No" in a quiet but firm voice, and praise him when he steps over. He also has a "step" command which I also use to encourage slow movement.

 

It did not take him long to get the concept although when he gets excited, he will tend to pop with his hind end. I think it might be a lot harder with a dog that does agility other than as a very rare occurance (Celt had some classes when younger and intermittently we have had some fun with jumps and a few other pieces of equipment, so it's not like he's an "agility dog").

 

Some people begin with just poles on the ground and I wonder if that might help you get her accustomed to stepping and not jumping.

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Hmmm its not like she has done much agility lately it will be 2 years in December since she has done much thanks for the thoughts will try some bars on the ground tomorrow with her.

 

Not great news here tonight after a fortnight of no 3 legging and the specialist saying he doesn't need to see her again tonight she raced off across the back lawn and was back on 3 legs. Grrrrrrrrr very frustrating.

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I'm feeling your pain right now. My mistake eight days ago set him back, and further mistakes on Wednesday just made it worse. So while he is better muscled and conditioned than he was way back when, he's on such limited activity that it will take time to get back where we were.

 

I think Shari is pretty disgusted with me right now, and for good reason. We'll find out how he really is tomorrow. No one to blame but me.

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To work on the cavaletti type exercises with Foster we actually used a ladder on the ground. She never did agility but did flyball. I did not have low enough jumps at the time or didn't want to make anything. The ladder worked pretty well.

 

Remember we all cause the dogs to have setbacks. These dogs just don't get it that they can't and shouldn't do some of things they are doing. They feel great and lure you into thinking they are better than what they are... it happens. Don't beat yourself up over it. We all do it and do it more than once. Shoot, if you want to find a way to punish yourself, when you "screw up" take something away from yourself that you really want. You correct yourself enough times and it makes you want to follow instructions. I am not making light of the situation just so you know.

 

After activities I would go back to icing the surgical leg again. If you are supposed to stick to a time limit for walks - take a stop watch with you or some other watch that reminds you that you are 1/2 way done and you need to turn around.

 

Good we love our dogs.

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Kim is right. We all make mistakes and setbacks happen. We had a lot of them as a good part of Tiga's recovery was during the winter/spring with lots of ice. We had also just moved from the suburbs to a second story apt. in the city. Don't beat yourselves up too much. It's a difficult point in the recovery because like Kim said the dogs fool you into thinking they're doing great and it's easy to buy into it because you've been working hard for so long. I found it hard to stay patient at points and just wanted my dog back. As for Shari, I'm sure she's seen much worse. Have you read through the "oops moments" on Orthodogs? Whenever we had a setback I would go read that and it always made me feel better knowing that other dogs had done much worse and came out ok. :)

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If it makes you feel better -

 

Foster's second knee surgery. Remind you had already been through this once before when Foster was 7 yrs old. This one she was 9 yrs old. We thought it would be easier since she was older and considered a senior. So 2 days after surgery she busted her surgeries open. You could actually see the bone. Off to the vets we go. She got staples and glue. She busted 2 more sutures 2 days later. Back to the vets. More staples. 2 weeks later after staples had been removed she had a nasty seroma (?). Why the seroma? Well, seems she was being way too active. She wasn't doing much but well it was too much. This was just 2 weeks after surgery. Add in the few times we would allow her on the couch (picked her up) so we could get some cuddle time in or do her ROM exercises. Yeah she jumped off the couch a few times. A couple times she got away from us outside and would try to take off running.

 

We finally had to really find a better way. I started disciplining myself for screwing up. I was being lax and knew it. My husband was being lax as well. You see Foster was pretty much putting full weight on the leg the day after surgery. She was progressing so well and we followed a very stringent rehab program.

 

6 months after surgery she was back to playing flyball even after all the screw ups.

 

There are many more screw ups during the 1st surgery and the 2nd. These were just a few.

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Kenz's situation is hard because there has always been a question mark on whether the surgeon wants to go back and do further surgery because it wasn't fully fixed the first time. Thats the really hard part of me. If I knew everything was fine and it would eventually resolve without any doubt on the situation I would feel much better about things.

 

She isn't on timed walks anymore. She is at the start of 17 weeks post-op so she is free to do as she chooses not restricted in anyway aside from not starting back with jumping/retrieving or tugging for another couple of weeks.

 

Its just hard knowing that her 3 legging is still due to the patella slipping which is what was happening before surgery. Its about as random as it was before surgery and the thing that really worries me is the history knowing this time last year they couldn't even find a patella luxation and she was still having random hind end lameness. Doesn't leave me with a lot of confidence knowing that its still potentially a problem and she is still having episodes as she was before.

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I would find your situation to be very stressful - it's one thing to know that a certain something has happened and another certain something will, with high probability, fix it. It's quite another thing to be left hanging, wondering, and questioning. I know that I find uncertainty to be more anxiety-producing than certainty, even if it's something that I'm not happy about happening, but at least I know where I stand and what's going to happen.

 

And, I hate to say it but we are not dealing with whether or not to bake a chocolate or lemon cake for someone, not knowing which they might prefer. We're talking invasive procedures, high cost (in some cases), and questionable futures for the dog.

 

I feel for you and hope for a very positive outcome to your worries.

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September 1 2012 - 10 1/2 weeks post-op and 8 weeks of therapy

 

It’s been two weeks since Celt’s last visit with Shari – two weeks marred by some misjudgments on my part that caused him pain and setbacks to his recovery. I’ve spoken about them already but in essence, I either overdid a strenuous exercise with him (stairs) and/or maybe hurt him when I fell walking him. Then, when he was supposed to be on limited exercise following this, DH made the mistake of taking him for what would be too long and too demanding a walk (through pastures and hayfields). So, as of two nights ago, he was on nothing but potty walks in the yard/near the house (just long enough for him to accomplish his business) and his ROM, with all other exercises suspended.

 

Now, since Shari had rightfully seen fit to chew me out on Thursday night for yet another episode of bad judgment on my part (she was sympathetic last week when I messed up the first time so far in our routine), I have to say I was a bit apprehensive about going today. Visions of her saying that I had knocked Celt back to his post-surgery stage or had done something dreadful were on my mind.

 

So today, Shari took some extra time just watching Celt walk around, to assess for herself what his state was (I did not give Rimadyl after last evening, so that wouldn’t interfere with her ability to read how he was feeling and affect how he was moving or responding to her treatments). He was obviously not at the same stage of progress that he had been at two weeks ago.

 

When she did the ROM and cold laser, she found a bit of stiffness in his right hind leg (the one operated on) but not too bad – he was a bit reluctant to let her stretch it out as far as usual but when he relaxed, as he realized it wouldn’t really hurt, she was able to get almost full extension, which was a good sign.

 

While I have been experiencing some resistance from him when I went to ROM his left front leg (and wondering if there was some pain/injury there), she found the opposite to be the case – he was more resistant and stiffer in the right front leg. That could explain his uneven gait even more, if he was hurting to any degree in both legs on that side. And, since I have no idea if or how I might have fallen or hit him when I fell last week, I have no idea if I might have hurt either leg in that incident, or if this was just a reflection of the front leg having to take up some slack from his not using his back leg like he should be doing.

 

When Shari did the three-legged dog with Celt, she limited it to only a few reps on each side, pointing out to me that he was reluctant to put his weight on the right hind leg. He would either try to move the foot (which he could because Shari was supporting his belly to a degree to make sure that he could not slip or fall) or he would “crouch down” a bit on that leg, which a dog will do when the leg is weakening.

 

We went on to the cavaletti, set at 8” only (which is all he’s done there, even though he does 9” at home because I can put books under the cones), and he did them very well, only hopping once or twice in a dozen reps. That was reassuring.

 

Since Celt had resisted sitting when I asked him to prior to the ROM, that was one of the exercises we did not do. He did sit twice but Shari and I could see that he was hesitant to do so and that he sat very crookedly, indicating that his leg was not ready for that level of exercise. It doesn’t sound like much but sitting does require leg strength – it’s like a push-up for the hind end.

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The only other exercise we did was the treadmill. And because Shari was not sure how well Celt would handle this, she timed each session based on how he was moving in it. She started with 2 ¾ minutes, which was half-a-minute less than his last sessions two weeks ago.

 

She pointed out how he started the first few seconds well and quickly tired but then, as he hit his stride, he began stepping better. Again, weakness was indicated by his putting his feet more under his body, the more easily to bear his weight – and that would result in his weaving a bit back and forth. This time, though, I noticed and she agreed that he was also doing that with his front end, which is not something we had observed before. This was probably due to the bit of soreness/stiffness in his right front shoulder.

 

Earlier videos show him striding nicely and widely in front. The video I got today shows how narrowly he is striding in front. This sort of thing is what I like about being able to work with Shari – there are things that are obvious, like a limp. There are things that are less obvious or not so intuitive to notice – like foot pad or nail wear; how he places his feet under his body and the weaving in the treadmill; clues in his posture or the placing of his legs. There are many times I might have said, “All is well!” when that really is not the case. Or, on the other hand, times when I felt there was no progress but there really was.

 

Here is a video of him from the side – even Ed could see that Celt was lifting that hind leg a bit higher (one of the indications early on in his treadmill work that it was weaker and sore) and not striding as long with it as with the other hind leg. The little bobble at the end was Celt getting distracted as I went to turn off the camera, stopping to look at me, and bumping into Shari at the back of the tank.

 

th_005-1.jpg

 

And a short video from the front, where you can see how he is placing his front feet almost one in front of the other, instead of in two separate walking paths like normal (an video much earlier in his therapy program shows that well).

 

th_006-2.jpg

 

I asked Shari how treadmill walking equated with walking on the dry ground and she said that while she could tell me the pace (or rate) at which he was walking (which she adjusts to the dog and his capabilities along with his size and build), there is no way to say that a minute on the treadmill equals so many minutes of regular walking. There are too many factors to consider – the resistance of the water along with the buoyancy of the water being the primary ones.

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Our routine for this week is sadly just about the same as it was for the very first or second week of therapy -

 

Two walks, no longer than 15 minutes each, and a third walk of 10 minutes or less either in the middle of the day or a couple of hours after the post-supper walk.

 

ROM exercises, six reps each, to the count of eight, on all four legs.

 

Three-legged dog - only six reps on each leg, to the count of eight.

 

Cavaletti - 12 step-overs.

 

Repeat to self - "I will not exceed the program Shari has outlined. My dog and I do not have to be over-achievers. Slow, steady progress is the goal and the key."

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  • 2 weeks later...

8 September 2012 - 11 1/2 weeks post-op and two months of rehab

 

The mystery of Celt’s issues over the last couple of weeks may have been solved – now we just have to deal with it. I was quite concerned about our visit, wondering how Shari would view him, improved, not improved, whatever. I’d been very careful to follow her instructions to the letter this last week – nothing but gentle walks, maximum of 15 minutes each, two to three times daily; ROM done gently; and a dozen step-overs (cavaletti) at 8” high, twice a day.

 

He had been on Rimadyl again for a few days – I’d called her on Monday as he had been three-legging it very briefly a couple of times, when getting up. And that was a first since just after the surgery, and had me very concerned. We finished the Rimadyl on Thursday morning so I knew that he’d be “natural” by Saturday, without that masking any pain. And while I worried if he would be visibly stiffer or more sore after discontinuing the Rimadyl, I had been very pleasantly surprised to find him seeming quite chipper and cheerful on Thursday evening and on Friday, as well as Saturday morning. But he still was not “right” and I was wanting to hear what Shari thought. I even wondered if the second internal stitch, working its way out at the top of the incision, could be causing a hitch in his stride if it was discomforting him – but I have never seen him licking or otherwise indicating that it was an issue, so I doubted that it was.

 

As always, Shari let him walk around a bit so she could observe him before she began the cold laser and ROM. I noticed that she didn’t seem to find any soreness in his back this week. That has become less and less noticeable over the course of therapy, although last week, when he was obviously bothered by something, he was showing a sore area again in his back. This week, no indication of pain or stiffness there.

 

As Shari worked the cold laser on his joints, she used her free hand to feel around and palpate/massage different muscle groups in his hind end – and then she found an area that was distinctly sore. There is a muscle group called the iliopsoas, that runs from several of the lumbar vertebrae and the ilium (part of the pelvis) to near the top of the femur, and functions as the major muscle to draw the knee forward and upward by rotating and flexing the hip joint, and it is important in pivoting movements. In the case of a knee injury, the dog’s holding that leg abnormally results in the Iliopsoas tending to shorten and tighten up. One of Celt’s ROM exercises targets that muscle by stretching it out.

 

033.jpg

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Apparently, while Shari and I had thought that Celt had a soft tissue injury in the knee area, it was this muscle that was hurting. It is a common muscle that is injured in athletes and from what Shari said and I have read, it can be a very painful injury as movement can result in spasms and cramping. So, while Celt may have been predisposed to a problem with this muscle by favoring his right leg after his original injury, it had not been a problem until either it was stressed by my overdoing the stairs several weeks ago; stressed by Celt moving to avoid my falling on him when I fell in the road during our walk that evening; injured if I fell on Celt in the road at that time; stressed by the pasture walk Ed took Celt on; or a combination of the above.

 

Last week, Shari did not detect pain or stiffness in this muscle but, by this week, it was obvious. She said that once it is injured, it can take a while to heal because activity may result in continued spasms and cramping, which perpetuates the pain and susceptibility to further spasms and cramps.

 

The good news is that with it being a soft tissue injury and not something relating directly to the knee itself, it should be able to heal with careful and gentle exercise and massage, without lasting damage.

 

Here is a picture showing the location of this muscle group (from rottendogblog):

 

iliopsoasmuscle.jpg

 

Shari decided that Celt was not ready for any of the strengthening exercises like the three-legged dog, backing up, sit/stand, or stairs but felt that with another week of improvement, we would probably begin to reintroduce these more stressful and challenging exercises. Meanwhile, he did the cavaletti (step-overs) at 8” very comfortably this week, much more smoothly than last week, in spite of the iliopsoas discomfort, which is probably an indication that he is already on the mend.

 

In the treadmill, his lack of more extensive walking and strengthening exercises was obvious. Shari had him walk for 2 ¾ minutes the first two sessions, but noted that he tired quickly, and it was especially obvious in the second session, and so she only had him go for 2 ½ minutes the third session. While he tired rapidly, his striding was improved from last week, and he was not weaving as much, so this was another indication that there was some improvement from last week.

 

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Something that I haven’t seen Celt do before was he was letting us know that he wasn’t that eager to remain in the treadmill – he was finding it tiring and after each session, he went to the entrance/exit, which was not like him.

 

Shari does not like using the Rimadyl for an extended period of time and so the vet at her facility examined Celt to see if that stitch was ready to remove (it’s not yet exposed enough for removal) and to provide a prescription for Tramadol, which Celt will be taking at least this week to aid in reducing the pain in the iliopsoas, and allowing him to use his muscles more freely in his walking and ROM.

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Our exercises for this week at home are designed to increase his exercise but keeping it gentle for the time being:

 

Two 20-minute walks each day, with a third walk of 10-15 minutes

 

ROM exercises as usual, making sure to keep them slow and holding the stretch, particularly on the exercise that stretches the iliopsoas (the hind leg backwards extension), with gentle massage on the iliopsoas muscle group to help relax and release the muscles, and relieve tightness and discomfort

 

12 step-overs (cavaletti) twice a day

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15 September 2012 - 12 1/2 weeks post-op and two months of rehab

 

After several weeks of setbacks, guilt, and worry on my part, and pain/discomfort on Celt’s part, I think we have turned the corner towards progress in recovery – and none too soon to suit me.

 

Between overdoing the stairs with Celt, falling down in the road (hitting him when I fell or him twisting to avoid me when I feel), and his hurting his iliopsoas muscle perhaps as a result of the first two issues, he has been hurting and we have been back to the very basic routine of short, gentle walks; ROM exercises; and 8” stepovers – plus Tramadol for the muscle pain.

 

Halfway through this past week, I thought I was seeing a difference in Celt – a brightness in his attitude and a bit of spring to his step, both of which have been missing these last few weeks as he was in pain. As the week progressed, though, I could see that he was seeming to become less introspective and more positive in his outlook, and his walking was again appearing to strengthen.

 

Shari could see a difference from the very first moment she saw him moving about at her practice. He was eager, his tail was jaunty, and his walking was quite symmetrical and forward. She spent a little more time than usual just watching him walk about, looking for signs of improvement or problems, and could see nothing but progress from the several previous visits.

 

On to the ROM and cold laser, where she found him to be his old, silly self – something we have noticed as he progressed away from his surgery in June. He shows his positive feeling at ROM time by getting silly – lying on his back, wiggling, and just being a bit of a clown. That was another indicator that he was feeling better this week. And when Shari applied the cold laser and ROM, he was very relaxed – always a sign that he is feeling good about the treatment and not feeling at all apprehensive that something might hurt.

 

Here he is while she’s treating his hind end, hamming it up for the camera:

 

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And then really getting into the mellow, relaxation mode – for much of his treatment (unless he heard me turning on the camera) he was laying as limp as could be with his eyes almost shut, even offering a stretch during some of the ROM exercises, extending his own legs as Shari guided him into position:

 

009-1.jpg

 

Shari next tried the three-legged dog exercise. It was very evident that he did not have the strength in his hind legs that he had several weeks ago, before all these setbacks occurred. However, when she tried this last week, it was painfully obvious that he was not ready to resume this exercise, and she could see enough improvement that this is again added to our twice-daily routine, but with a strict limit.

 

She also had me do the walking-backwards exercise with him, just a couple of times, but decided that he was just not strong enough right now to resume this, particularly as we want to avoid anything that might stress the iliopsoas muscle that now seems pain-free, but which would be very painful if strained again. An aside that I find interesting is that Celt has never been very adept at walking backwards – while both Dan and Bute, each of them very leggy and lanky dogs, have always readily walked backwards with longer strides.

 

We went on to the cavaletti (step-overs) where Celt did very well at the 8” height, and which we will continue to do at home but still remaining at that height and not trying to progress back to 9”. This week, he was again showing that he could step over with either hind foot leading, whereas in the last two visits, he was favoring the bad leg by stepping over first with it while he rested his weight on his good leg.

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The underwater treadmill was our last exercise. He's ready and waiting to go:

 

012-3.jpg

 

Last week, Shari had not been able to let him walk more than 2 ¾ minutes at most, and had to limit the last rep to only 2 ½ minutes because he was tiring and weaving so much. Since he had shown such improvement otherwise since last week, and was seeming to have no apparent pain, she started him at 3 minutes. The first session, he started out well, weakened at about 1 ½ minutes into the session, and then began walking better again.

 

This is the beginning of his first session, and he is going quite nicely here – his strides are relatively even and strong, he’s not weaving (yet), and he is looking confident – all improvements from last week:

 

th_011-3.jpg

 

His second session was, as Shari described it, “beautiful”. I think that sometimes, since he hasn’t been on the treadmill for a week, his first session may start out with him moving strongly but he can lose his “rhythm” partway through. The second session, it is like he has a second wind – he’s adjusted to working on the treadmill, has a rhythm and stride established, and does better. The third session is when he begins to tire partway through, which seems natural.

 

Last week was the first time I have seen him seem reluctant to do the treadmill. He entered well enough but was very quickly tiring and weaving – and, each time between sessions, he would go to the back to the entrance, and stand looking out. He has not done that before and I think it was an indicator that he was not feeling well, he was hurting, and he really didn’t want to remain in the treadmill – which has always been a part of the therapy visit that he has shown obvious anticipation in doing.

 

Today, Shari tried him at 3 minutes, and he was able to do all three sessions without having to stop early. And when all was said and done for his therapy session, he trotted to the door with tail held high and wagging, letting us both know that he was feeling very good - and feeling very good about feeling very good!

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This week’s exercises are:

 

Two 20-minute walks and one 10-15 minute walk for the first half of the week, with one big change – I am to walk him on the hilly part of the walk on the diagonal (I call it “The Drunken Dogwalker” walk), back and forth across the road, which will provide slightly higher and lower levels for each hind leg as he walks, both uphill and downhill.

 

Two sets of ROM exercises daily.

 

Six reps only, each side, of the three-legged dog exercise, twice daily.

 

About 12 cavaletti (step-overs) at 8” high, twice daily.

 

Tramadol twice daily, with a meal.

 

On Wednesday, if he is doing well and strongly, I can increase the twice-daily walks to 25 minutes each (with an additional 10-15 minute walk either mid-day or at bedtime, depending on the day) and decrease the Tramadol to ½ tablet twice daily with meals (or if it doesn’t split well, just one tablet daily with the evening meal).

 

Hopefully, we will be able to work him back up to his pre-setback recovery and routine fairly quickly but for the time being, Shari wants us to take it slowly and carefully, to avoid re-hurting his iliopsoas muscle, which can be very painful and can take time to heal if the damage is more than inconsequential.

 

Meanwhile, I'm finding it interesting to do the diagonal walking on the hill part of the road - Celt hasn't figured out why I am walking so strangely but he's adapted pretty quickly. But when I also have Megan on the leash, well, looking like a drunken dogwalker is a conservative way of describing it...

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22 September 2012 – 3 months post-op and 2 months of therapy

 

I can remember back in June and early July, when thinking ahead three or four months seemed like forever, and now it’s been a little over three months since Celt’s surgery (19 June) and almost three months into rehab and therapy (7 July).

 

We went in a couple of days early because I wasn’t going to be able to take him in on Saturday, so it was only five days since his last session rather than the usual seven, and I wondered if we would see much improvement. I felt I was seeing improvement in those few days, with him seeming to be striding more strongly, tiring less quickly, and showing more strength in his exercises – but I also wondered if I was “seeing” what I was hoping to see or actually seeing progress.

 

On schedule, on Wednesday morning, I cut his Tramadol back to half a tablet, twice a day (I could be doing that as a whole tablet once a day as an alternative). Shari explained that Tramadol is fairly short-acting, wearing off in about 8 hours and that is why she said I could be giving a dose three times a day if needed. So far, in the time he’s been on the Tramadol, I have only been giving a dose with each morning and evening meal, and he hasn’t seemed to have much discomfort.

 

At the same time, I increased his two primary walks to 25 minutes each. The additional walk, which takes place mid-day when I am home and able to do that, or in the evening shortly before bed when I am not, is either 10 or 15 minutes, depending on the time of day. I was concerned about reducing the Tramadol and increasing the walk time at the same time but I was glad to see that Celt did not seem bothered by either change.

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Lisa came in from NC and so got to go with me to Shari’s for Celt’s appointment, and it was enjoyable to have her company and to be able to share what we are doing with her. As always, Shari let me walk Celt around the foyer and her treatment room so she could observe him before the session. I didn’t give Celt his Tramadol before heading to the evening appointment so she could see him without any pain being masked by the medication, which is what she wanted.

 

I could tell by the smile on her face that she was pleased with what she saw. He was walking in a very relaxed but energetic fashion, without obvious shortness of stride or any discomfort visible. She administered the cold laser and ROM exercises, being very pleased with his range of motion. The front legs are at maximum extension, the good hind leg pretty close to maximum, and the bad hind leg at about 90%, which is pretty good for this point in his recovery. And he was showing no sign of pain in his iliopsoas muscle or in his back, which were also good signs.

 

Another positive response was seen when she did his three-legged dog exercise. He had had a lot of hesitation at the last session with this, not wanting to do the exercise and apparently not being able to rest his weight on that leg very well. I had felt he’d improved throughout the five days and she said the change was obvious and very positive, as he is now able to hold that pose without discomfort or shifting his leg unless it is not in a good position to begin with.

 

Again this week, she had me do the backing up exercise, which he is now able to do well enough that that is back on our list of “things to do this week”. He so readily did the 8” cavaletti that she tried having him do the 10” but, as always, while he *could* do it, it was not something he *wanted* to do as it was a bit out of his comfort zone, so we will be doing 9” at home this week, which he does quite readily. For a dog his size, 10” is an effort to step over, even when sound, so it’s a challenge to get him to do it even when he’s doing well.

 

We went to the room with the steps and he did the baby steps very well. He was improved on the regular-sized steps but she still felt he was not ready to do those at home, where we have to do ten in a row going down or up. If I had a stoop or something with just four or maybe five steps, I think she might have given the go-ahead to try that, but not with our ten, steep steps to the basement. But, he was improved on the limited number of regular steps (four), which was a plus.

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And on to the treadmill, which went very well, and of which I got a short video taken, but which I am having no luck uploading to Photobucket so far – but, if I do, I will post it here. It is, easily, the nicest bit of treadmill video I’ve been able to record – good, even, straight, steady strides.

 

He did three sessions of 3 ½ minutes each, the longest he has ever done, even prior to these last few weeks’ setbacks. And he stayed steady and strong for each one, not getting his usual getting-tired-and-losing-his-rhythm problem that usually happens about a minute and a half into his first session. And, while he was tiring partway into his last session, he was still striding well and steadily, so Shari let him continue to the 3 ½ minute point even in that session.

 

I find it quite fascinating to watch his legs during the treadmill sessions – there are so many different indicators of how he is doing that aren’t obvious. A dog that is weak in the treadmill tends to prance with each leg, particularly the least sound leg. Strides are, of course, shorter. But a weaker dog will also tend to place his/her feet underneath the body more, rather than the feet (and legs) tracking in two tracks, right and left. So the feet will be placed in an over-lapping position, which will lead to weaving rather than walking straight. Plus, a dog that is weight-bearing well on a leg will place the foot down and you will see the toes splay slightly as weight is applied. The toes of the foot on the leg that the dog is favoring and not putting weight on, will not splay out like the toes on the other feet.

 

So it’s not just looking at the bad leg and how long a stride it is making, it is looking at the whole picture – the movement of the leg, the placement of the foot, the weight-bearing of the foot, and so on, that indicate sometimes much more obviously what is happening than just the stride.

 

I always find it interesting that since the treadmill, the last exercise, *makes* the dog use the unsound leg in ways that dry-land walking doesn’t, Celt’s stride is always improved outside of the treadmill, for at least a while. He gets into the habit of using the leg, and that continues into his walking afterwards. I could see where use of an underwater treadmill on a more regular basis could really help a dog make progress towards a normal, symmetrical, even stride after trauma and/or surgery.

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This week’s exercises are:

 

Two 25-minute walks a day, with a third walk of 10-15 minutes (we did cheat and walk 20 minutes mid-day on Sunday, as we were enjoying the walk with daughter, Laura, and grandson, Matthew, who were visiting the farm to enjoy some time with Lisa while she was in town)

 

ROM exercises as usual, twice a day

 

Three-legged dog – upped to 10 reps on each leg, to the count of eight, twice a day

 

Walking backwards – we do about three reps of 6-8’ in length, twice a day

 

Caveletti – 12 reps at 9”, twice a day

 

So far, he is doing well – lots of energy, not seeming to tire, handling his increased exercises without discomfort or showing signs of tiring. Except for not doing any stairs at home, we are now back to where we were when we hit our setbacks. So that means it’s been about four weeks to recover from the injury or strain that occurred at that time (which I now am quite convinced happened when I fell in the road and either hit Celt in falling, or he twisted/strained himself in avoiding me – and perhaps he was “primed” for an injury by my overdoing the stairs with him that morning).

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Last evening, the second internal stitch that has been working its way to the surface, was removed. We've been keeping an eye on this one. The first one that did this, at the top of the incision, was finally snipped and removed by the vet where Shari's practice is located. Enough of the stitch was exposed that the vet could snip it and draw it out, including the knot (we'd been waiting for that to surface so that she could snip and pull).

 

The end of this stitch has been exposed for some weeks now but until yesterday evening, there was not enough of the stitch at the surface to be able to remove it. Last evening, I noticed a callous-like buildup by the stitch, which appeared to have a loop or knot within it. I pried it loose with my fingernail and it came away, bringing the stitch with it. It appeared that the knot was within the callous.

 

Now, one more stitch, at the bottom of the incision, is beginning to work its way out. I can just feel a small bump and see a little hint of blue (the stitch material is blue) but that one's still a long way from being able to be removed - not even an end is poking out through the surface.

 

This is not uncommon although I wonder why these few end stitches (end stitches, with their knots, are most likely to do this) didn't just simply get absorbed into the tissue like the other stitches.

 

These don't seem to bother Celt in the least and he doesn't fuss at them, but they concern me as they provide a channel for bacteria to move under the skin and into the tissue once an end has poked its way out to the surface. However, so far, no sort of infection has occurred and I hope it stays that way.

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