A sheltie protest…
Ticket is doing great 2 weeks post-op. She had her 2 week recheck appointment today, and everything is looking great. Still some mild effusion of the stifle, but nothing unexpected. She continues to use the leg well. She also had her initial rehab evaluation, and is looking great there as well. She is basically just like she was at this point after her first TPLO surgery in terms of muscle mass, flexion, and extension, just with the legs reversed. She had her first underwater treadmill session today for about 10 minutes, and tolerated it with the same martyrdom she does ALL water. At least here, she gets cookies.
At home, we’ll be going to 10 minute walks twice daily, but watching closely for any change in gait or lameness. I’ll continue to use ice after these walks to decrease any resulting inflammation. True to my pledge to be more “aggressive” with rehab this time, we have another appointment on Friday morning. Yup, my Black Friday will be spent fighting traffic across from the largest mall in Houston (The Galleria) to get my girlie 10 minutes on the treadmill. Then onto work in the afternoon. Tulsa or bust!
We’re taking it slow and steady, despite Ticket’s reassurance that she’s feeling fine, and her desire to sprint with abandon to the finish line. This is one race where slow and steady really will win it. Her recheck xrays are scheduled for 12/28, and I assure you, it can’t get here soon enough. 🙂
So, the first two weeks of TPLO recovery are pretty boring in the scheme of rehab. Not a lot to be done just yet. Ticket is doing well, except that she is definitely more of a handful then she was the first time. She’s already grabbing her leash to tug, bringing me her toy in the xpen, etc. It’s going to be a long 8 weeks. But she’s using the leg well, no more of the post-op swelling, and she’s about as relaxed and happy as she can be.
Here’s the lowdown of what we’ve been doing. While it’s not as exciting as cavaletti or underwater treadmill, it may be the most important part of rehab. It’s much easier to do everything you can to maintain range of motion then to try to get it back once you’ve lost it. The ice also helps a lot with the inflammation in the joint.
Passive range of motion exercises involve laying your dog down, and moving the joint through it’s normal range of motion. You want to support the leg, and not force the motion too far, or to the point where your dog is uncomfortable. I’ve been doing about 15 reps three times daily, followed by ice. 5 days post-op, I started using a warm wash cloth to help warm the joint before the exercise. It is important to not start heat right after surgery, as heat can make the post-op inflammation worse. I also always do these exercises after taking Ticket outside for her 5 minute potty break, so the joint is as warm/loose as possible.
Warming the leg before exercise
Flexing the knee
Extending the knee
Icing the knee afterwords
I prefer flexible therapy gel ice packs–easier to mold to funny-shaped joints. Make sure you keep something between the ice and the skin so it’s not too uncomfortable for your dog.
Clearly unable to relax
Here’s a break in election coverage for you… Ticket had TPLO surgery on her RIGHT stifle yesterday, and was able to come home today. Surgery went well, however, her cruciate injury was atypical. Usually when a dog injures their cruciate ligament, it’s the medial aspect of the knee that’s affected, and that was the case with her left stifle last year. This time, the medial aspect of Ticket’s knee looked perfect–all the damage was on the lateral side. Her lateral meniscus was damaged, and there was a lot of cartilage damage on that side. What that may mean for her career long-term remains to be seen. I can’t find a lot of information out there about dogs with damage to their lateral meniscus. Only time will tell, I guess. In the meantime, we proceed with rehab and recovery just like any other CCL injury.
I was very sad when I saw Ticket yesterday about an hour post-op. She was on a CRI (continuous rate infusion) of Fentanyl, and she stood to see me, but was very out of it, and obviously painful, holding her leg up. I didn’t see her this soon after her first surgery, and it threw me for a bit of a loop. I started to think about all the horrible things that could happen, etc. So I was very relieved when I went to pick her up today, and she drug the technician down the hall, was using her leg, and was her normal, happy, wiggly self. THAT’S my girl. She settled into her xpen quickly–she’s not *quite* herself, which I attribute to the pain I’m sure she’s in despite her medications. She was happy to chill out most of the afternoon–her favorite pose involves her sprawled on her back with her feet in the air. Crazy pup.
Physical therapy right now is pretty simple. Gentle passive range of motion (pROM) of the knee, hip, and hock, about 10-15 reps, 3 times a day. Followed by an ice pack for 15 minutes. She gets a 5 minute “walk” three to four times daily, which basically is just a trip outside to potty. If I keep her at a walk, she uses the leg, otherwise she will carry it when moving faster. I’m doing laser therapy on her daily for the first 3 days, then will go to twice weekly. I’m also planning on starting to acupuncture some points starting tomorrow if she will tolerate it. Her leg looks pretty good right now. She obviously has some swelling around her knee, and a little bit of edema and bruising around her hock. Not too much to see otherwise.
So far, so good. Pretty much “as-expected” this soon after surgery. She will start more organized physical therapy in 2 weeks.
