An ACL tear and TPLO journal

[Sue R]

29 September 2012 - 14 1/2 weeks post-op and 12 weeks of therapy

 

I feel like I am walking on a cloud today, Celt’s therapy session went so well. Or maybe I should say that Shari was so pleased with his progress that I am really feeling positive about how things are going, and Celt’s progress towards soundness and comfort.

 

Our visit was early in the day and Celt had had nothing more than breakfast (no Tramadol before his visit so it couldn’t be masking any pain or discomfort) and two quick trips to do his potty business before we set off – into a very foggy morning, with deer everywhere along the roads, and even groups of chipmunks goofing off on the pavement here and there. So I had to drive slowly and with extra care.

 

I was excited for this visit as I have really felt that Celt has been visibly improving over this last week and a half, and was hoping that this visit would confirm that he was making positive strides in recovery. He was so pumped for the visit that, as soon as we turned off the main road onto the road to the clinic, that he began to “woof” his excitement.

 

As always, Shari watched him just walk and trot around naturally so she could have a good feel as to how he was using that leg totally on his own and in different positions that he would normally assume. She was pleased, seeing him putting more weight on the leg and striding more evenly, his right leg having a stride that was hardly noticeably different from that of his good leg.

 

Shari did the cold laser and ROM exercises, and he lay on the mattress like a pasha on his couch, with his attendants at his service, with me stroking his head as Shari worked her magic. I told her that the second upper stitch that had been working its way out was now gone – he had formed a bit of a callous of dry skin around it, which I was able to prise loose with my fingernail, and it pulled off with the knot embedded in it and the loop of the stitch following. There is now one new one coming to the surface, at the bottom of the incision this time, and it will be a few weeks probably before that comes out enough to remove. This seems to be a commonality with the end stitches on incisions by this vet but it’s rather immaterial so not a worry as long as it doesn’t allow bacteria to get under the skin and result in an infection.

 

The very next thing she did was to have him stand and she measured his thighs. In his very first visit, the difference in circumference was 4 cm, which was to be expected with atrophy on his right leg (the one with the torn ACL). Three weeks later, the difference was 5 cm, which was the opposite of what would be expected except for the fact that Celt had been on close to crate rest for about two months prior to surgery – and this was reflecting that both legs had been weakened by lack of exercise, and the sound leg was just recovering more quickly than the leg he was using less.

 

At the next measurement (we’ve been measuring every three weeks), we were both happy to see the difference had been significantly reduced, to only 3.1 cm. And then Celt experienced his setback, with the next measurement a couple of weeks into that phase – and it measured 4.5 cm, which was very disappointing. But, at that time, not only was the leg atrophying with reduced exercise but it was also very flaccid as she measured, and so the difference was even more noticeable.

 

Three weeks later, and we were both astonished to see the difference was only 2 cm this time, the best measurement in this whole course of rehab. Time for a big smile and a big hug for Shari and myself, and a treat for Celt! She could see the improvement and feel the improvement, but the measurement gave the proof that he is back on the mend.

 

Next, Shari did the three-legged dog and, with Celt’s increased strength and stamina, decided to have me alter this exercise. Instead of 10 reps on each side, with the one leg drawn up in the same position as his first ROM exercise (“folding” the one leg as if it were in a sitting position, flexing all the joints), his new routine will be only six reps. When the right leg is up, it will be as previously done. When I have the left (or sound) leg up, I am to extend it backwards (as in the third of the ROM exercises), which will move more weight to the right leg and make him have to balance a bit more, both good exercises for him to increase strength and stability.

 

Here is the position for the right leg up:

 

Insert

 

Here is the position for the left (sound) leg up:

 

Insert

 

We did our backing up exercise, which is probably the one Celt has the most difficulty with. He’s never been good at this and Shari has to look closely to see an improvement. But she offered the suggestion that all dogs tend to have one exercise they have the most difficulty with. While many find the step-overs (cavaletti) to be the problem exercise (and I don’t understand why that is), Celt simply seems to find this one to be his problem exercise, or the one he just seems to not do well. And the reason for that could be the ligament injury – if he’s had a level of injury to that ligament for some time (which he apparently had for at least three years), maybe he’s just been uncomfortable doing that motion for a long time, and he might never get over that muscle memory.

 

On to the cavaletti (step-overs) – Shari has been trying him at 10” for a number of visits but he has not been successful. He’s been at ease with 8” almost since his first visit, and he’s been at ease and doing 9” for most of two months, he’s just not transitioned to 10” when she’s had us try that. She’s been sure he had the strength and flexibility to do it but he’s continued to “bounce” over when she’s had us give it a try.

 

She has a non-skid flooring in the clinic but I know that he seemed more comfortable doing this exercise at home, on carpet, since the beginning – when he could do a dozen reps without a skip at home, but we’d have to struggle to get a few at the clinic. So I went and got the “encyclopedic dictionary” in two volumes from the attic (my cones only go to 8” so I needed a 2” lift – the smaller books I’ve been using have only given a 1” lift, to give us the 9” height) and gave this a try during the week.

 

I only had him do 9” for the first few days after his last appointment (a week ago Thursday). Then I would have him do most of the reps at 9”, change the books, and try to get a few at 10”. It took patience as this is getting hard to do simply because he is not that tall and it is an increased effort. By Thursday, we were doing nothing but 10”, even though it would take some tries for him to get settled enough that he would do the 10” consistently without bouncing or hopping. The least bit of excitement and he would tend to get silly and bounce because it is easy and not so much effort or thought involved.

 

So I was excited to show Shari this and hoped that he would “perform” for her by cooperating. And maybe also just feeling comfortable enough to do this on the different floor surface. She set up the three cavaletti at 10” to give it a try, and it took a couple of passes before he settled down enough to show her that he could do it right. She was concerned at first (as I had been at home) to see that he was leading each time with his right leg but, as he relaxed and got into doing it right consistently, she was pleased to see that he could and would do it with whichever leg was in the right position to take the step-over. It is easier to lead with the leg that isn’t as weight-bearing and so being able to do this as readily with either leg is a positive sign.

 

Shari has tried him on the baby and regular steps each of the last few weeks but felt he was just not ready for the steps at home to be added to his routine. This week, he did the baby steps with ease, as usual. He did the regular steps well but only when I made sure that I was doing it right – as on the cavaletti, I needed to use the leash to regulate his pace to a slow, thinking walk. When I did that (just as on the cavaletti), we got a good result. And so steps will be added back to his routine, but very carefully. We are not rushing anything but being very conservative, to avoid overdoing things and causing any injury or setback again.

 

The treadmill session was great! There is no other way to say it. Shari watched him work the first session and had him go for 3 ¾ minutes, his longest yet (last week, at 3 ½ minutes was the longest up to that time). He did not seem to weaken as much at a minute and half in as he often does, when he switches from being very fresh to having to “regroup and rethink” because it’s work and it’s tiring, and he has to get into a sustainable rhythm.

 

He did a second session of the same length, and then Shari set the treadmill at a slightly faster rate of speed, as she could see that he was having to limit his foreleg steps to meet the treadmill speed instead of being able to stride at the pace that was natural for him. And he did wonderfully at the increased speed. Like last week, she was very pleased and felt this was his strongest, best stamina session so far. It was visible that he was putting weight on all four legs like he should.

 

Shari pointed out that Celt’s right leg’s stride would probably never be quite as long as that of his left leg because the angles of his joint were altered by the surgery. While he extends that leg back in the stride just as much as the left leg, he does not bring it forward quite so much. This is probably why dogs that have had a TPLO on both hind legs do so very well and often recover much more quickly with the second surgery – their strides become symmetrical and even after the second surgery (and their owners are experienced with dealing with recovery and rehab).

 

If he continues to improve like he’s doing, he may be ready for sit/stands next week but taking it carefully, we aren’t going to rush into too much that’s new – he already has changes in his three-legged dog, adding the stairs, and doing 10” step-overs.

 

This week’s at-home routine is:

 

Two 30-minute walks a day, with a 10-15 minute mid-day or bedtime walk

 

One rep only of the stairs per day – 10 steps, down and up again, under good control for a slow, careful step

 

ROM as usual twice a day

 

Three-legged dog exercise – six reps each side, hind leg extension on the left hind leg only, twice a day

 

Backups – about 12-15 total, twice a day

 

Cavaletti (step-overs) – 12 reps at 10” height, making sure he’s doing them with both hind legs leading and not just one, twice a day

[Sue R]

29 September 2012 - 14 1/2 weeks post-op and 12 weeks of therapy

 

I feel like I am walking on a cloud today, Celt’s therapy session went so well. Or maybe I should say that Shari was so pleased with his progress that I am really feeling positive about how things are going, and Celt’s progress towards soundness and comfort.

 

Our visit was early in the day and Celt had had nothing more than breakfast (no Tramadol before his visit so it couldn’t be masking any pain or discomfort) and two quick trips to do his potty business before we set off – into a very foggy morning, with deer everywhere along the roads, and even groups of chipmunks goofing off on the pavement here and there. So I had to drive slowly and with extra care.

 

I was excited for this visit as I have really felt that Celt has been visibly improving over this last week and a half, and was hoping that this visit would confirm that he was making positive strides in recovery. He was so pumped for the visit that, as soon as we turned off the main road onto the road to the clinic, that he began to “woof” his excitement.

[Sue R]

As always, Shari watched him just walk and trot around naturally so she could have a good feel as to how he was using that leg totally on his own and in different positions that he would normally assume. She was pleased, seeing him putting more weight on the leg and striding more evenly, his right leg having a stride that was hardly noticeably different from that of his good leg.

 

Shari did the cold laser and ROM exercises, and he lay on the mattress like a pasha on his couch, with his attendants at his service, with me stroking his head as Shari worked her magic. I told her that the second upper stitch that had been working its way out was now gone – he had formed a bit of a callous of dry skin around it, which I was able to prise loose with my fingernail, and it pulled off with the knot embedded in it and the loop of the stitch following. There is now one new one coming to the surface, at the bottom of the incision this time, and it will be a few weeks probably before that comes out enough to remove. This seems to be a commonality with the end stitches on incisions by this vet but it’s rather immaterial so not a worry as long as it doesn’t allow bacteria to get under the skin and result in an infection.

 

The very next thing she did was to have him stand and she measured his thighs. In his very first visit, the difference in circumference was 4 cm, which was to be expected with atrophy on his right leg (the one with the torn ACL). Three weeks later, the difference was 5 cm, which was the opposite of what would be expected except for the fact that Celt had been on close to crate rest for about two months prior to surgery – and this was reflecting that both legs had been weakened by lack of exercise, and the sound leg was just recovering more quickly than the leg he was using less.

 

At the next measurement (we’ve been measuring every three weeks), we were both happy to see the difference had been significantly reduced, to only 3.1 cm. And then Celt experienced his setback, with the next measurement a couple of weeks into that phase – and it measured 4.5 cm, which was very disappointing. But, at that time, not only was the leg atrophying with reduced exercise but it was also very flaccid as she measured, and so the difference was even more noticeable.

 

Three weeks later, and we were both astonished to see the difference was only 2 cm this time, the best measurement in this whole course of rehab. Time for a big smile and a big hug for Shari and myself, and a treat for Celt! She could see the improvement and feel the improvement, but the measurement gave the proof that he is back on the mend.

[Sue R]

Next, Shari did the three-legged dog and, with Celt’s increased strength and stamina, decided to have me alter this exercise. Instead of 10 reps on each side, with the one leg drawn up in the same position as his first ROM exercise (“folding” the one leg as if it were in a sitting position, flexing all the joints), his new routine will be only six reps. When the right leg is up, it will be as previously done. When I have the left (or sound) leg up, I am to extend it backwards (as in the third of the ROM exercises), which will move more weight to the right leg and make him have to balance a bit more, both good exercises for him to increase strength and stability.

 

Here is the position for the right leg up:

 

 

Here is the position for the left (sound) leg on the way up:

 

 

And the left leg extended:

 

 

We did our backing up exercise, which is probably the one Celt has the most difficulty with. He’s never been good at this and Shari has to look closely to see an improvement. But she offered the suggestion that all dogs tend to have one exercise they have the most difficulty with. While many find the step-overs (cavaletti) to be the problem exercise (and I don’t understand why that is), Celt simply seems to find this one to be his problem exercise, or the one he just seems to not do well. And the reason for that could be the ligament injury – if he’s had a level of injury to that ligament for some time (which he apparently had for at least three years), maybe he’s just been uncomfortable doing that motion for a long time, and he might never get over that muscle memory.

[Sue R]

On to the cavaletti (step-overs) – Shari has been trying him at 10” for a number of visits but he has not been successful. He’s been at ease with 8” almost since his first visit, and he’s been at ease and doing 9” for most of two months, he’s just not transitioned to 10” when she’s had us try that. She’s been sure he had the strength and flexibility to do it but he’s continued to “bounce” over when she’s had us give it a try.

 

She has a non-skid flooring in the clinic but I know that he seemed more comfortable doing this exercise at home, on carpet, since the beginning – when he could do a dozen reps without a skip at home, but we’d have to struggle to get a few at the clinic. So I went and got the “encyclopedic dictionary” in two volumes from the attic (my cones only go to 8” so I needed a 2” lift – the smaller books I’ve been using have only given a 1” lift, to give us the 9” height) and gave this a try during the week.

 

I only had him do 9” for the first few days after his last appointment (a week ago Thursday). Then I would have him do most of the reps at 9”, change the books, and try to get a few at 10”. It took patience as this is getting hard to do simply because he is not that tall and it is an increased effort. By Thursday, we were doing nothing but 10”, even though it would take some tries for him to get settled enough that he would do the 10” consistently without bouncing or hopping. The least bit of excitement and he would tend to get silly and bounce because it is easy and not so much effort or thought involved.

 

So I was excited to show Shari this and hoped that he would “perform” for her by cooperating. And maybe also just feeling comfortable enough to do this on the different floor surface. She set up the three cavaletti at 10” to give it a try, and it took a couple of passes before he settled down enough to show her that he could do it right. She was concerned at first (as I had been at home) to see that he was leading each time with his right leg but, as he relaxed and got into doing it right consistently, she was pleased to see that he could and would do it with whichever leg was in the right position to take the step-over. It is easier to lead with the leg that isn’t as weight-bearing and so being able to do this as readily with either leg is a positive sign.

 

Shari has tried him on the baby and regular steps each of the last few weeks but felt he was just not ready for the steps at home to be added to his routine. This week, he did the baby steps with ease, as usual. He did the regular steps well but only when I made sure that I was doing it right – as on the cavaletti, I needed to use the leash to regulate his pace to a slow, thinking walk. When I did that (just as on the cavaletti), we got a good result. And so steps will be added back to his routine, but very carefully. We are not rushing anything but being very conservative, to avoid overdoing things and causing any injury or setback again.

 

The treadmill session was great! There is no other way to say it. Shari watched him work the first session and had him go for 3 ¾ minutes, his longest yet (last week, at 3 ½ minutes was the longest up to that time). He did not seem to weaken as much at a minute and half in as he often does, when he switches from being very fresh to having to “regroup and rethink” because it’s work and it’s tiring, and he has to get into a sustainable rhythm.

 

He did a second session of the same length, and then Shari set the treadmill at a slightly faster rate of speed, as she could see that he was having to limit his foreleg steps to meet the treadmill speed instead of being able to stride at the pace that was natural for him. And he did wonderfully at the increased speed. Like last week, she was very pleased and felt this was his strongest, best stamina session so far. It was visible that he was putting weight on all four legs like he should.

 

Here are side and front videos but not very good quality:

 

 

 

Shari pointed out that Celt’s right leg’s stride would probably never be quite as long as that of his left leg because the angles of his joint were altered by the surgery. While he extends that leg back in the stride just as much as the left leg, he does not bring it forward quite so much. This is probably why dogs that have had a TPLO on both hind legs do so very well and often recover much more quickly with the second surgery – their strides become symmetrical and even after the second surgery (and their owners are experienced with dealing with recovery and rehab).

 

If he continues to improve like he’s doing, he may be ready for sit/stands next week but taking it carefully, we aren’t going to rush into too much that’s new – he already has changes in his three-legged dog, adding the stairs, and doing 10” step-overs.

[Sue R]

This week’s at-home routine is:

 

Two 30-minute walks a day, with a 10-15 minute mid-day or bedtime walk

 

One rep only of the stairs per day – 10 steps, down and up again, under good control for a slow, careful step

 

ROM as usual twice a day

 

Three-legged dog exercise – six reps each side, hind leg extension on the left hind leg only, twice a day

 

Backups – about 12-15' total, twice a day

 

Cavaletti (step-overs) – 12 reps at 10” height, making sure he’s doing them with both hind legs leading and not just one, twice a day

 

One-half Tramadol after this morning's session and this evening, and then discontinue the Tramadol unless he seems to need it.

[Sue R]

Question for Shari (Celt's therapist) - is it time or distance that counts for his walking exercises? I've realized over the last couple of weeks that as he is recovering nicely again, his walking pace has become faster and stronger. So, while we've been increasing our distance by what we paced out in his first few weeks of rehab (adding "5 minutes" of distance), what used to be a 5-minute distance is now a 4-minute distance.

 

So, when I thought he was walking for 30 minutes, I timed it today to find that that distance only takes 25 minutes - so we walked further to make it 30. But, to avoid jumping too fast ahead, I need to check with her to make sure. After all, increasing the distance by a percentage is just as valid as increasing the time by the same percentage, but we are not making our time goals right now without increasing the distance a bit more. Just a thought. Things are going very well, though.

[ness_bc]

Sue R - I ended up going on distances rather than time because as your finding I found time less reliable. Our rehab schedule was to increase the distance by 10% twice a week. Its what Kenz's surgeon normally uses for rehab post joint surgery.

[Sue R]

Thanks for your observation! Although I knew that time depended so much on a number of factors, I just didn't think about it as clearly as you have stated.

 

I spoke to Shari last evening - I think she thought my question a bit silly, and it didn't help that she was calling towards the end (but not the end) of her very long day. She said to go with whichever suited me, that it wouldn't be a significant difference.

 

I wonder how well my message ("Nothing wrong, everything fine, just a question") got through to her - I left the phone number I wanted her to call on twice on the message but she called me on a different phone, and she seemed concerned that something was wrong and not just that I had a question. Perhaps I wasn't as clear as I thought.

 

My idea is to do the distance that is simple (just a round-trip from here to there) on the two or three mornings a week that I work, since it's dark and time is limited. Then to do the longer distance in the evenings when I have both daylight and more time, to get that longer, half-hour equivalent in so that we are increasing his activity.

 

Thank you for your comment - that makes it sound so simple and straightforward!

[ness_bc]

No problems - that sounds fair enough. Kenz is having a fairly average time of her rehab. Nobody can work out what is going wrong and she is now 22 weeks post-op and started having fairly significant issues with both hind legs. She had a trip to the neurospecialist yesterday and a full neuro exam but he is pretty confident he doesn't think its a neuro issue.

 

This week all her lameness/non-weight bearing episodes have involved her surgery leg which is bizarre since she has been mostly good for the last few months. I feel like I am hassling her surgeon every few days with a new incident. I am not sure it should be looking this way anymore.

[Tiga's_mom]

We went with distance with Tiga as well. We live in the city so every time we had to increase, we just went an extra block.

[2 Devils]

Can you video Kenzie so we can see what she is doing? Many of us have been through all this before and we may see something. What kind of surgery was it again?

 

1. Could it be scar tissue? It may be pulling really tight and feel like it wants to rip. I know from experience that sucks. My scar tissue did finally rip and it was painful but did finally feel better.

 

2. Maybe muscle problem.

 

3. Arthritis

 

4. Out of adjustment

 

5. Toe issue

 

It could be many things. Have there been any recent xrays done? If the current vets can't figure it out maybe try a holistic vet as they actually get there hands on the dogs. They may feel something out of whack. Sorry you are having so many issues. It sucks.

[Sue R]

Distance versus time - I find time easy to gauge because I can look at my watch. I find time hard to gauge because a lot affects it - the rate at which Celt walks, stops to potty and sniff, and so on.

 

I find distance here in the country to be rather subjective - so far, I've been fortunate at being able to choose a "marker" that I thought would be about right and, when I've timed it, found that I could readily add five minutes (2 1/2 minutes each way) by guessing a new and easy-to-remember landmark (usually a tree or gate or turn).

 

I find that one day, we may cover a segment in five minutes and the next day in four, or six...

 

So I'm rather looking at the round-trip walk as 25 minutes equivalent, and that's what we are doing in the morning when I work because of time limitations and it being dark. Then when I'm not working or in the evening, we do the same trip but repeat sections of it so that I see that we are getting in at least 30 minutes of walking time (realizing that there are a few minutes spent pottying and sniffing, but that's always been the case) so we are *relatively* increasing the walk time/distance by a reasonable amount.

 

Shari isn't one to recommend more than about 30 minutes per trip, at least not now. I'll probably be increasing the mid-day walk (on days off) or the bed-time walk (on work days) to get in extra exercise, along with adding whatever other in-house exercises she recommends.

[Sue R]

Those are some good ideas, Kim. I hope that will help pinpoint Kenzie's problems. It must be awful just not knowing what is the problem. At least when you know what it is, you know how to deal with it or what to try to do to alleviate it.

 

I hope it works out for Kenzie.

 

Somedays, I think it would be nice to have predictable conditions and distances, like in town. But that idea fades very fast, and I'll just deal with estimates!

[ness_bc]

Will start a new thread so as not to hijack this one further. She has the experts stumped in a big way.

[Sue R]

6 October 2012 - 3 1/2 months after surgery and 3 months of rehab

 

To be brief, all went very well. Celt is showing improved strength, muscling, balance, putting weight on his legs, and stamina.

 

All exercises went well, including the stepovers (which, at Shari's, are actually about 11" rather than 10", the max his build should allow), stairs, and treadmill.

 

The treadmill sessions were increased to 4 minutes each - he was strong and steady. His normal "meltdown" that occurs at about 1 1/2 minutes into the first session as he tires a bit and gets sloppy with his striding, and which usually takes about 10-15 seconds before he straightens out and recommits to a good, steady stride, didn't happen until almost three minutes in, and was resolved in just 3-4 strides, a big change. He got a bit tired in the third session but again, as in the previous two weeks, this was his best treadmill session yet.

 

Good use of the hind leg although it is apparent that, due to the changed angle of the knee joint, he will probably always have a slightly shortened stride on that leg but which doesn't appear that it will be an issue as he seems quite symmetrical and not having to compensate much if at all.

 

Adding a little more of stairs and adding some sit/stands while keeping all else the same for this week's exercises.

 

Two 30-minute walks and one 10-15 mid-day or late-day walk daily

 

One round-trip on the steps (about 10 steps down and back up again) twice a day

 

ROM exercises as before twice a day

 

Three-legged dog - six reps each leg, extending the good leg when standing on the surgery leg twice a day

 

Walking backwards about 12-15 feet or so twice a day

 

Step-overs (cavaletti) 12 reps at 10" twice a day

 

Sit/stands 5 reps twice a day

[Sue R]

13 October 2012 - almost four months post-op and 14 weeks of rehab

 

And another good visit with Shari! While I think I see progress during the week, it’s always what Shari sees that matters to me because she sees a lot that I don’t, for better or worse.

 

Shari was pleased with Celt’s walking, his level of energy, and his attitude. He’s becoming more and more energetic, more ready to take on the world, and more comfortable in his body, so to speak. We spent about five minutes total, just watching him walk around and show just how “normal” his gait and posture have become since his surgery.

 

During her pre-ROM exam, she found a bit of either stiffness or pain in his mid-back, a place where he’s had a bit of discomfort before, and wondered if it might just be due to the cooler weather and the early start to the day. When we go later, like 10:30 am, we’ve had a chance to take a good warm-up walk before the short drive (it’s about half an hour) but it was both chilly (very frosty, our coldest fall morning yet this year) and I was short of time so we didn’t take any more time walking than it took to do his business – which was a very short bit as he’s pretty regular in his habits.

 

By the end of his cold laser therapy and ROM exercises, she did not detect any discomfort in his back so she felt it was likely just the cold morning and the early start. She noted how, from the beginning of his sessions, his hamstrings have tended to be a bit tight but other than that, he is showing excellent range of motion in all his stretches.

 

She checked his three-legged dog exercise and, since he’s doing really well with that, tried the two-legged dog (diagonal legs up and extended) but he showed her he isn’t quite ready for that right now.

[Sue R]

I was extremely pleased that he did his walkovers at 10” (her poles actually measure about 11” high, and he tends to brush them with his stifle as he walks over as they are definitely at his upper limit), all 12 of them, without a single hop, skip, or bobble! It’s hard enough to get him to be “serious” and not excited and distracted when doing these so that he might do them without “mistakes”, and this was his best series ever. Hooray for Celt!

 

He did two sets of backups. He’ll never be a backup star, and Shari thinks that his knee problems may have been developing long enough that this is his default mode – short, rather shuffling steps, but still better than he was doing some weeks ago. I used to have to have hands on him to get him to back and now he will back on command with just a hand signal and my body pressure moving towards him, so it’s all an improvement.

 

He did well on both the baby and regular stairs and, like the step-overs, did not get silly and hop or skip. He’s a dog that will offer behaviors and, with a little agility training in his earlier years, he often offers a little jump when there’s some sort of obstacle. It’s been a challenge to get him to w.a.l.k. during his walks, step-overs, and stairs but he seems to have the concept down quite well after all these weeks.

 

The treadmill was good. Shari noticed he was short-stepping in his first 4-minute session so she increased the pace yet again (she did that two weeks ago) and he was able to walk with a more comfortable, more natural stride. She did two more sessions with him but since she’d increased the pace, she did not increase the duration this time. And, while I did side-view video of two of his sessions, the slower and the faster, I misjudged and the videos are longer than I can upload to Photobucket to show here (and I don’t have an edit program for this type of file) so I can’t share them here. Too bad, because they are nice quality and demonstrate his progress throughout most of a 4- minute session.

 

I need to arrange a different way to make video where I have better control of the buttons but I run into the problem that my moving to the side of the treadmill to turn the camera off and on distracts Celt, and I try to minimize that – and wind up not turning things on and off properly. Meanwhile, I have a some good, longer videos of his sessions to look at for my own review, so it’s not all bad.

[Sue R]

Pleased with his progress, she increased his exercises to these for this week:

 

Two 30 minute walks daily, with another 10-15 minute walk either mid-day or at the end of the day, depending on my work/at home schedule – but the big change is that he can be off-lead on the homeward leg of each walk (as long as he is reasonable, and so are the other dogs). And he can do part of his walks in the pasture, either a homeward leg or another part of the walk. (So far, he’s had a couple of pasture walks on the five-minute segment coming down the hill to the house, making sure he’s getting plenty of fresh calf manure to replenish his B vitamins and gut flora.).

 

Two sets of stairs (10 down and 10 up), twice a day, after his walks.

 

ROM exercises as usual, twice a day.

 

Three-legged dog, 10 reps, twice a day.

 

Backups of about 20’ in distance, twice a day.

 

Cavaletti (step-overs) – 12 step-overs, twice a day.

 

Sit/stands – 5 reps, twice a day.

 

So, the walking distance/time stays the same but with more freedom (some off-lead) and more challenging surface (some pasture). Of course, off-lead, he will actually cover a little more ground in the same time as before since he will choose to trot more and to sniff and check things out more randomly than he can on-lead.

 

The problem with being off-lead is that he chooses to trot a lot more. He goes and sniffs, trots to catch up or to move ahead, stops to sniff. The walking is much more beneficial in building muscle, balance/symmetry, stride, and weight-bearing, which is essential to his progress. But, at this point, Shari has mentioned that he is about ready to start some trotting rather than just walking. Plus, I am noticing that his trot gait is getting quite even and relaxed.

 

His three-legged dog is increased to his pre-setback level; his stairs are doubled; and his sit/stands are doubled.

 

Since several things are increased, I am to observe him carefully and cut back to previous levels of one or more of the exercises should he seem to be uncomfortable with these. So far, he is loving the increased freedom and doing well with the increased activity – he is actually acting like he’d like even more!

[Sue R]

20 Oct 2012 - four months post-op and 15 weeks of rehab

 

I have to keep reminding myself that while recent progress seems slow, that initial progress tends to seem fast but it's the latter progress that tends to be slow by its very nature, and that all progress is good. Plus, we lost about a month of progress when Celt had his set-back, and so that also makes it seem like things are going slow.

 

Another good visit and an important one to me because we wouldn’t be back for two weeks, with Celt and myself going out of town for what turned out to be six days, thanks to Hurricane Sandy and her cold-front cohort from the West.

 

Not much in the way of news, as Celt did everything pretty well. Here he is, “suffering” through his cold laser treatment, which Shari administers along with his ROM exercises.

 

[Sue R]

Shari decided he is ready for the two-legged dog. Here are two photos illustrating how it is done on each side. For the side where I am holding up his bad leg, I am to be careful to put my hand inside his thigh rather than inside his stifle, to avoid putting pressure on the plate in his leg.

 

Here is the exercise with the good leg being lifted, so Shari (in the early stages of this exercise) is supporting Celt with her leg.

 

Shari decided he is ready for the two-legged dog. Here are two photos illustrating how it is done on each side. For the side where I am holding up his bad leg, I am to be careful to put my hand inside his thigh rather than inside his stifle, to avoid putting pressure on the plate in his leg.

 

Here is Shari lifting his good hind leg (and diagonal foreleg). In the early stages of this exercise, before he becomes proficient, she's supporting his balance and bad hind leg as needed with gentle pressure from her leg.

 

 

When she lifts his bad hind leg (and diagonal foreleg), she is careful to position her hand so as to not put pressure on the plate in his leg.

 

 

This is not an easy exercise for either of us. I asked Shari how she made it look so easy and she said that if she made it look hard, no one would be willing to do it! It took me a few days to get comfortable doing this with Celt (I was not at all successful some weeks ago when we first tried to introduce this) but once I got the hang of it, it became pretty routine quickly.

 

I found that for me, the key is to lift the front leg on the side where I am standing, reaching over his back to lift the hind leg on the other side. I think my problem in trying this previously was that I tried to lift the hind leg on the side near me, and that just did not work for me to do this successfully.

[Sue R]

The one thing that we did that was different was to take him outside to a long set of wooden stairs. The inside stairs have about eight steps for the baby steps but only four steps for the standard-sized steps, and so this was his first test run for Shari to observe on more than just a few steps.

 

We went down, and then back up again, and Shari was pleased to report that he seemed to show no problems in either direction. The stairs were not steep and were wooden, and I felt he was more comfortable than on the inside stairs that have non-slip (abrasive) inserts.

 

He got quite a start afterwards, though, as we stood outside to talk over his stair work. He leapt about his head-height in the air as he saw what must have been a scary sight – Lola, the wolf that is being treated and rehabbed after a leg injury, came walking stealthily up to a nearby fence. She was in the turnout yard for some fresh air and wearing a very wide, bright blue and patterned soft e-collar.

 

Talk about a combination of someone’s worst nightmares – wolf plus clown! No wonder Celt levitated when he became aware of her. She is quite shy and I was amazed at how quickly and quietly she could move about. Blink your eyes and she’s there – blink them again, and she’s gone.

 

[Sue R]

The exercises for the next two weeks are:

 

Thirty-minute (we can and do go further at least once a day – on my days off, he gets more walking than on work days, but always at least a total of an hour on the work days, and at least an hour and a half on my days off) walks twice a day, with another walk in between when I can. On leash for part of the time and off leash and/or in pasture or hayfield for part of the time.

 

Two sets of stairs, twice a day.

 

ROM as usual, twice a day.

 

Two-legged dog, five reps each side, twice a day, being careful to avoid putting pressure on the plate in his right hind leg.

 

Backups of about 20-30’ at least, twice a day.

 

Stepovers at 10”, twelve reps, twice a day.

 

Sit/stands of eight reps, twice a day.

 

Now, with us being gone to Tennessee, I knew it likely that we would miss some exercises that I just could not do with him, and that it could be a bit of hit-or-miss on some others, but Shari said not to worry and just do the best we could.

[Sue R]

27 Oct 2012 - over four months post-op and 16 weeks of therapy

 

After a hiatus of two weeks, a trip to TN that turned into a seven-day trip thanks to Hurricane Sandy and the cold front from the West, Celt had his appointment. I was a bit disappointed at his work as he seemed a bit stiff on the bad leg and tired more than I would like to see in the treadmill. However, some of that was due to me not being diligent at getting his exercises in regularly and completely on our trip. Some of the exercises, we simply could not do away from home and equipment/facilities. Some of the problem was that I just didn’t do everything I should have done on a twice daily basis. Another problem was that Celt was uneasy doing some of his work away from the security and familiarity of home, and the easy surface of the carpet that offers comfort and traction.

 

We resumed our full program when we got home on Wednesday evening, so he had just a couple of days of the routine before this visit, after almost a week of hit-or-miss exercises. And, since I’d forgotten to bring a leash, all of his walking was off-leash, so he didn’t get the consistent walking that is so good for strengthening his legs. But he sure had fun running around and being a “normal” dog again, too.

 

He was a bit stiff and resistant on his surgical leg for the ROM that followed the cold laser. All other legs seemed quite relaxed and supple. And he was a bit uneasy for his three-legged dog, not as consistent as I felt he’s been at home.

 

He did the stairs well but Shari noticed him putting both front legs on the first step down each time, and she hadn’t observed that before. I think he does that at home a bit, and I think he is just “setting himself up” for the downward trip rather than having a “problem”. She thought that might be the case and I need to watch him at home to see if this is a pattern.

 

His stepovers were really good and Shari said that if I was pressed for time, that would be the exercise I could leave out or reduce sometimes. That’s sort of a shame because that’s my favorite one, and he seems to enjoy it very much, too.

[Sue R]

His backups were not outstanding, as usual. And Shari added a new exercise, stepping sideways. He didn’t cooperate all that well for her on this as it was new and he kept wanting to look at me for reassurance but when I tried it, it went well in both directions. I did get a short video but he is stiff and hesitant in it (I’m sort of pushing him across the floor), but I’ll post it here just to show in general what this new exercise is about. He was much more relaxed and fluid when he wasn’t distracted by the videoing that Shari was doing.

 

Here are the two of us ready to give sideways walking a try. One hand is on the collar and the other is right under his flank (more like a one or two fingers there, actually) to keep that hind end moving evenly with the front end.

 

 

And here we are, trying it, but not very well.

 

This week’s exercises are all the same as last week, except to add the sideways stepping. Rather than increasing anything else, Shari is giving him a week to get back into the routine, hopefully build some strength, and add just the one new item to our routine.