As some of you may know, we are the proud owners of two Springer Spaniels, Willow and Mason, who are 18 months old as of 5th October. Both are indeed characters, and their energy levels keep us on our toes. However, recently following walks, Willow has developed a limp and struggled to get up. It was not every time she went out, and the intermittence of it initially suggested a muscle strain. The lameness would generally last about 24 hours, and while she didn't give any indication of pain, the way she carried herself suggested that she was in some discomfort. Also when in a sitting position, her legs were too far underneath of her and splayed out to the side, making it difficult to rise and get to her feet again. Initially, we asked the net to carry out some preliminary investigative work when she went for spaying at the end of July 2018. Due to the way she was sitting and her bouts of occasional lameness, we first suspected that she had a problem with her hips, so we asked for these to be X-rayed while she was under anaesthesia as part of the keyhole surgery we had booked. The X-rays didn't show anything abnormal, and for the next few weeks, there were no reoccurrences of the problems she had experienced.
Towards the end of September 2018, she was back at the vets. We had been on a reasonably long walk, and afterwards, Willow was again showing some discomfort and when walking would do so with an arched back. The vet advised us to have some further X-rays done, concentrating on the areas of the knee, so we arranged an additional appointment for these to be carried out.
I guess at 18 months you don't expect anything serious to be wrong. Although we knew something was not quite right, at such a young age, you want the problem to be something such as muscle strain or a ligament tear which will eventually resolve itself. The X-rays indicated something different. They showed that Willow has Degenerative Cruciate Disease in both her hind legs, with ruptures of the cranial cruciate ligament. When you hear something like this, it is a shock, and most of what the vet tells you doesn't really sink in. The only thing you take away is the word operation and prolonged recovery. To have the procedure in one leg is bad enough, but the thought of going through all this and then at a later date having a second operation to correct the other leg was overwhelming. The vet seemed to think that the left joint was the worst of the two, with a greater build-up of fluid and strain, and some early signs of arthritis. It was, therefore, decided that this should be the one operated on first.
Willow's pre-op X-rays are shown below. If you click on the relevant image you can see the X-ray in greater detail.
Left Stiffle Joint
Right Stiffle Joint
For those of you who don't know, the cranial cruciate ligament is one of several ligaments which are part of the knee structure and provides stability to the joint. It is analogous to the anterior cruciate ligament (ACL) in humans. This condition is the result of the angle of the tibial plateau becoming sloped too far back, so there is a constant stress on the cranial cruciate ligament. Rupture of this ligament can damage other parts of the knee leading to further damage to the knee and cause further pain. To treat this, Willow will undergo a surgical technique called Tibial Plateau Levelling Osteotomy (TPLO), which involves a radial cut of the tibia which is them rotated to change the angle of the joint, effectively leveling the tibial plateau. The parts of the bone are fixed into this new position using a special bone plate and screws. This procedure eliminates abnormal motion and provides greater stability of the knee. An outline of the steps involved during the operation can be seen below. The vet also mentioned that he would probably add a suture, called a fabello-tibial tuberosity suture, which offers additionl support.
Although not in constant pain, we felt that it would be better to have the operation carried out at a young age as delaying the treatment can lead to chronic progressive arthritis in the stifle. The surgery also has a very good success rate with the dog regaining full mobility after a few months and eventually being able to carry out strenuous exercise.
We are aware that some of our customers' pets have experienced this condition and have used our Advanced Joint Support as part of a plan to maintain health and mobility. Willow is also taking the supplement and will continue to do so as the time passes. We thought it might be useful to record her progress as she undergoes major surgery and through her recovery but we also felt it was important to share our story of managing this whole situation.
Life over the next six months is not going to be easy for any of us. Apart from the surgery itself, one leg at a time, there will how to manage her - keeping her calm, keeping her confined and limiting her movement, being super strict with her diet so that she does not gain any weight and keeping her mind occupied. Then there is her interaction with Mason and his energy; there'll be no more chasing each other or wrestling that they both enjoy.
Though we are devastated that Willow has to go through something like this, especially at such a young age, we hope that by sharing our story some good can come out of this which might help others who are unfortunate to be in a similar position. We would also like to hear from other owners who have experienced this and what worked for them following the operation and during the period of rehabilitation.
You can expand the relevant sections below to see the full details.
While the TPLO surgery might be fairly routine, it is a major operation and the rehabilitation period looks to be a little more challenging from all the research we have conducted so far. Willow will have her first operation done on the 15 October, so the upcoming week is all about preparing for this. Firstly, there are going to have to be changes in work patterns and environments for someone to be on hand in case there are any difficulties and to monitor her behaviour. Experience has shown us that she isn't a good patient, she cries a lot and struggles to settle down when she doesn't feel herself. Maybe she'll surprise us, and everything will go smoothly, but it's best to try to prepare for every eventuality.
Then there are the practical things. The purchase of a baby/pet gate to limit her space but also so that if necessary, we can separate the two dogs, allowing Mason to have free movement about the house. Moving furniture around so that she can't do her usual jumping around. These changes have also included moving her crate so that we can access her easier when it comes to playing some crate games and keeping her entertained. We are also testing out a snuffle mat that we are considering adding to our product range.
We have learnt that Willow definitely doesn't like any sort of change. Even the moving of her crate has caused her much confusion; when we tell her to go to her den, she runs to where it used to be, spins around a couple of times and then looks to us as if to say, "where the hell is it?" This is the exact reason why we have moved it a week before the operation; we want to create a new routine for her that she is happy with and get accustomed to. We don't want to add stress to what will be already a drug confused mind when she returns home after her operation.
The vet advised us that in the build-up to the operation we should limit the amount of exercise Willow had and stop her putting too much strain on her back joints. We were also given some painkillers but didn't use these as she wasn't showing any signs of pain or discomfort. We did, however, stop her from doing some of the usual things which she enjoys. When she has been play fighting with Mason, she sometimes gets a bit too excited and starts to run at full speed around the room on a circular route. She jumps on or over any furniture in her way and purposely runs closely passed Mason to try and get him to chase her. When she does this, we say she has gone Bonsai, and it usually continues for a few minutes until she starts to get tired. We didn't want her doing things such as this so when we say that she was starting to reach this state, we tried to calm her down or distracted her.
09 October 2018
We now realise how difficult it is going to be to keep Willow on minimal exercise for a prolonged period. This morning she has been running around with Mason as full speed jumping over obstacles and rolling around play fighting. She has never been one for sitting still, in fact, she can't sit still for two minutes. The slightest noise and she wants to know what it is and will be up to investigate. I think she will be spending a lot of time confined to her crate or on the lead. Will also need to keep her separated from her brother Mason as much as possible as when they are together; chaos seems to reign.
Not entirely sure how much movement she will have in her leg once she has had her operation but wanted to try and make things as easy as possible for getting her in and out of the house so she can go to the toilet. At our back door, we have a couple of steps going into the garden so wanted to build a ramp to negate the obstacle. We looked at a couple on Amazon, but these were not really suitable as they were too big, seemed quite flimsy, or were extremely expensive for a temporary solution. We have quite a bit of spare wood so constructed something suitable which would help to get Willow in and out of the house. To give her more grip when on the slope, I covered the plywood with an off-cut of carpet which we have had for several years.
I had a little help from Mason while building the ramp if you can call stealing off-cuts of carpet and bits of cardboard from the garage help. He did, however, do some quality control testing and checked to make sure no trolls were hiding underneath, so it would be safe for his sister to use.
We have never felt so bad in our lives taking Willow to the vets. While we know that we are doing the right thing and that in the long term Willow is going to benefit hugely from these two operations, the guilt we felt when dropping her off at the vets was immense. She has no idea what was going on or what was about to happen. One minute Willow was running around the house at full speed, quickly followed by a real rough and tumble play fight with her brother, less than an hour later she is at the vets, shaking like a leaf. In her mind, I'm sure she probably didn't realise there was anything wrong with her legs because it didn't really stop her from doing the kind of things she enjoyed. Hopefully, this is not something she will not hold against us.
Our appointment was at 8:00 am, so we set off early to avoid the motorway traffic and arrived there a little early. Willow was reluctant to go through the door into the vets. She had recently gone to be spayed and a couple of weeks before had to go in for her exploratory X-rays. It doesn't take long for an animal to grow to hate the vets.
We had a short consultation with the vet, where he did a few tests, such as listening to her heart, and we filled in the usual pre-operative paperwork. I hereby give my consent for the procedures outlined opposite; I confirm that my pet has not eaten for 12 hours, etc., etc. The plan is to operate on the left joint today and for Willow to stay at the vets until tomorrow evening. We were told we could call between 3:00 pm and 4:00 pm to see how the operation went.
I managed to get a copy of the X-rays taken before and after the operation, which can be seen below. All of these can be clicked on to see the image in more detail. The initial image shows a pre-operative X-ray which was taken to accurately calculate the corrective angle required to level the tibial plateau, while the other two show post-operative X-rays with the special plate in place.
It should be mentioned, that the operation carried out was slightly different from the one described above. This alternative technique called a tibial wedge osteotomy (TWO) involves removing a wedge of bone from the front of the tibia and closing the gap with the aide of a wire loop. As with the more common type of procedure, this alters the angle of the joint and means that the cranial cruciate ligament is no longer required. As with the other kind of corrective procedure, a bone plate and screws are then used to immobilise the cut in the bone until it is fully healed.
After calling at 3:00 pm, we were told that she had just gone into recovery and was very sleepy. The operation had gone well, and she was on an intravenous drip to administer a painkiller. They were going to try her on some food latter and eventually take her off the drip and start with painkillers in a tablet form to prepare her for coming home the next day.
At around 9:00 pm we had a call from the vet who carried out the operation. He confirmed that the surgery had gone well and the joint looked to be in good condition with no damage to the cartilage. The cranial cruciate ligament was not torn completely or separated from the bone but would have gone this way if left untreated. Since the operation carried out negates the need for this fibrous connective tissue this was cut and removed.
We had an update from one of the nurses in the morning to say that Willow had a comfortable night and was able to come home this evening. When we got there, later in the day, and went in to see the vet, he ran through the pre and post-operative X-rays he had taken, and the medication she would needing to get her over the procedure.
She was prescribed three lots of tablets to take:
- Rimadyl - this is a very commonly used non-steroidal anti-inflammatory drug (NSAID) designed to relieve pain and inflammation. Rimadyl can cause various side effects in some dogs, including decreasing appetite, vomiting, and diarrhoea. I remember neither of our last two dogs could use the drug and became really sick. Luckily Willow seems to be alright taking it and doesn't cause any problems with her.
- Pardale-V - this is a prescription-only canine painkiller similar to Paracetamol and is used in veterinary medicine for dealing with acute pain.
- Clavaseptin - this is a broad spectrum antibiotic designed to prevent the wound from being infected. It is a commonly used treatment of periodontal infections in dogs and skin infections in cats.
When our pets have to stay in the vets for any length of time, all you can think about is getting them back home. When they do get home, however, you come to realise how much hard work it is going to be looking after them. Willow has to stay in her crate for three weeks and can only come out for the toilet.
When she came out of the vets to go home, she seemed to be using her leg reasonable well considering that it had been broken in two only the day before and had no pot, bandage, or another type of support in place. I think this must have been a desperate act to escape the vets considering what they had done to her, as when she got home she was much more reluctant to use it. The plan was to lead her into the back garden so she could relieve herself and then put her in her crate for a couple of hours until she was due to take her next lot of tablets. As the Rimadyl in particular needs to be taken with food, we were also planning on giving her some dinner as well as we are not sure when she had her last meal at the vets.
Unfortunately, when we took her into the back garden, she wouldn't do anything and was very reluctant to walk at all. She would walk forward one step and then turn around quickly to try and lick her leg. We ended up moving her straight into the crate, and she eventually went to sleep.
We did put on her something called a Comfy Cone, which is an alternative to the usual hard plastic Elizabethan collar, designed to help protect animals from aggravating the wound during their recovery. We have used this one on Willow before, and the design is flexible as it is manufactured from soft fabric and she doesn't seem to mind it too much. The main problem with this was the size. The one we had was kind of small and in most cases would have been fine; however, in this case, she was just able to reach the area where the procedure was done. There was some protection on the wound in the form of an adhesive surgical dressing, so she was not able to get to the stitches. We did, however, order a similar cone which was a larger size.
This is the type of protective cone which we are using for Willow. It is made from nylon fabric laminated onto foam, so is soft and yielding, and generally allows greater comfort to your pet. As it is not rigid plastic, associated with the traditional design of Elizabethan collar, its design conforms to doorways, and other openings for unobstructed freedom of movement.
We give her some food at around 9:00 pm. She had some sardines, which are a great source of calcium, together with the other bone-strengthening mineral, vitamin D so ideal to help with her recovery. They are also a great food to hide away a series of tablets and joint supplement. We took her out once again but it was a real struggle as she didn't want to use her leg at all. The only way she would move was to lead her out with a tempting treat which made her forget about her injury for a little time at least. It was a real two person job with one person holding the lead and trying to support her, whilst the other person moved forward with treats. Again it was a wasted trip as she wouldn't do anything again so it was back to her crate for the night. Willow has a bit of a track record when it comes to holding onto the contents of her bladder. When she was spayed, and we brought her home, it was about 24 hours before she eventually decided to relieved herself.
I slept at the side of her create overnight to make sure she was alright, and she seemed to sleep well once she had got herself into a comfortable position.
We leaded Willow out again in the morning but again didn't want to do anything. She eventually laid down on the cold flagstones and refused to move. It was a case again of leading her using treats back to her crate. She was not moving particularly well again moving a one or two steps forward and then turning quickly to try and lick her wound.
When they are spending so much time in their crate it is important that they continue to get plenty of water. We have a portable collapsible bowl made from silicone, which we use when they go out for a walk, so it is easier to use this rather than trying to drink from their usual bowl when you are taking them out into the garden so they can go to the toilet.
The wound could not be seen very well because of the adhesive dressing, but the whole area around it was very swollen. Some people have reported that after similar operations they have seen significant bruising after two or three days, but this has not been the case with Willow.
At around 4:00 pm she stood up in her crate and started to cry and bark, so we took her outside again, and finally, she emptied the contents of her bladder. This was almost 24 hours since we collected her from the vets so not sure the last time she actually went.
She has been a lot better in the crate than we expected. She usually doesn't spend a lot of time in there, only when we are having a meal or if the fighting with Mason starts to get a bit out of control. She has slept quite a lot, and when awake we have given her a cube to play with which contains small pieces of carrot. This at least gives her some positive stimulation while in the crate and using carrot instead of some form of kibble means that she is not overeating.
This is a good place to mention Willow's diet. Obviously, if your dog is much less active than usual, it is essential to cut down on their food intake as they are burning much fewer calories.
We have been introducing some other types of food to feed her, mainly ones to help fill her up, without adding loads of extra calories, and ones which are a good source of calcium or help to build bone density.
One of the things we had, were some bones which we had bought for the two dogs and put in the freezer so decided to use these to make some bone broth. We allowed the bones to thaw fully and then put them in a pan covering them with water. They were then covered with a lid and brought to the boil. Once up to temperature we turned this down and allowed the bones to simmer for a couple of hours. After this time we removed the bones and let the liquid cool. Once cool a layer of fat forms on the top of the liquid, and we disposed of this. We decided to read how to make bone broth after we had made our attempt and there are a few things we should have done differently. It helps to add apple cider vinegar or some lemon juice to the bones as this helps to draw out the nutrients, and the bones also need to be boiled for much longer than we did. Something else we have been giving her is broccoli which is a good source of calcium.
While watching Willow walk it was obvious that something wasn't quite right with her turning around after each step. We had a good look at her leg, and we were thinking that the adhesive dressing may be causing some issues. It looked that to be very tight and while walking was possibly pulling on the skin making matters worse. Additionally, in some places around the edge of the dressing, the skin was quite red as though it was rubbing in places. We were due to go to the vets again on 19 October but decided to try and get her seen today and see if they could remove the dressing. The adhesive part of the dressing was attached to the skin very firmly, and we were wondering how on earth this was going to be removed. We had visions of them grabbing one end and quickly ripping this off as though waxing her leg, but thought they must have some better solution for dealing with removing things like this.
We had an evening appointment at 06:00 pm to see the vet. We put her in the back of the car on a folded quilt, and I sat on the back seat and stroked her to stop her from moving about too much. On arrival at the vets, it was clear she was not too keen to go in. I lifted her out of the car and carefully placed her on the ground, but she wouldn't move and was sat rigid. Eventually, I had to concede defeat and carry her into the surgery. Doing this may have been a good idea anyway, considering the slippery surface in the vets.
The worry about removing the dressing was unfounded, as they had a solvent spray which once applied allowed it to peel off with ease. The actual wound looked well with five stitches in place but it is still very swollen. There was a bit of a rash caused by the dressing, but we have, since going to the vets, being treating this with Sudocrem, which is an antiseptic cream.
With the wound exposed, we decided to switch to her larger collar so she couldn't get to her stitches. This caused a slight problem as she was not able to turn around easily as the edge of the collar kept getting stuck on the bars of the crate. We decided to move her to Mason's crate which is a larger size and was initially purchased to hold them both when they were younger. It has caused a bit of confusion to both dogs but is only a tempory measure until she has her stitches removed which is due 26 October.
The swelling on the leg has not really changed any since the time of the operation, and is still substantial. Although the wound looks to be fine, there has been a little discharge from the top section of it. This is a clear thin fluid, not a thick yellow, or greenish coloured purulent cloudy secretion normally associated with infection, so not really concerned. We also noticed that some bruising had developed on the top of the inner leg, which can be seen in the image below.
Willow was starting to get a bit fed up been confined to her crate for most of the day. Late in the evening, she had a bit of a reprieve, and we let her out of the crate for an hour or so. We had to make sure that she didn't move about too much so we took her soft basket with me and my wife at either side and got her to lay down in that. We also had her on a tight lead so she couldn't suddenly dart off. One of the things she like to do is jump on things and get into an elevated position. A couple of times she has tried to do this by getting on a bench in the garden and on the sofa while she is walking passed it. She seemed to enjoy all the attention she was getting, adopting her favourite sleeping position, on her back. She was reasonably relaxed but was kicking her poorly left leg out every now and again, possibly through irritation from the stitches, so had to be careful that she didn't catch this on anything.
Willow hasn't been drinking too much over the past couple of days, and with having two dogs, it is difficult to try and gauge what her normal daily intake of fluid is. We decided to give her a little milk to keep her hydrated as this is something we know she will drink straight off. It should be noted that some dogs can have difficulties digesting lactose, a natural sugar found in dairy products. This intolerance is due to some dogs being unable to produce a sufficient amount of enzyme called lactase to break down the lactose. Willow doesn't seem to have any side effects with having small amounts of milk. Willow has also been getting some fluids from her meals, as we have been adding a little of the bone broth we previously made to it.
Willow's walking has been a lot better today, and she has been trying to move around in her usual manner at 100 mph. To try and slow her down we have been walking her outside with someone in front of her, but she is still determined to be the first one out of the day. She is also starting to put more weight onto her injured leg and has begun to jump up at the outside fence and when you have some form of treat in your hand. We have obviously been trying to minimise this as we don't want any complications to the healing process.
We have been trying to continue to get more fluids into her, and as well as a little milk, we have tried her on a product called Aptus Sport X, which contains natural essential minerals and salts. These electrolytes are designed to rehydrate, but that is if you can actually get your dog to drink it. We used to use a similar product on our previous dogs, and they thought it was some special treat. We would mix it in water and fill their bowl, and in no time at all, it was gone. Willow wasn't too keen, and although she drank a little, it was a bit disappointing that she didn't seem to enjoy it so much.
We tried her with a new toy today to attempt to entertain her for a while. This was a square of silicone with a raised pattern on it and is called a dispensing mat feeder or lick mat. The idea is that you smear some food on it, and the dog will then lick the mat to get to it. You can add foods such as peanut butter, natural yoghurt, and you can even freeze the treats onto the feeder before using it to make it last even longer. Since the mat has a raised pattern design, this catches the food and makes it harder for your dog to consume the treat you have used.
We used some tinned sardines along with a bit of spreading cheese, and she seemed to enjoy this, with the activity lasting around ten minutes. We have ordered some more of these with different patterns and will try them out again later freezing them with some natural yoghurt.
It has now been a week since Willow had the surgery on her left leg. I think things have been a little easier than I originally anticipated and Willow has been progressing well. We have been advised by the vet to keep Willow in a crate for three weeks and not to let her do anything regarding exercise during this period, other than going outside for the toilet. I certainly think that Willow could do some light exercise even after a week, but we don't want to jeopardise her recovery so we are following the instructions we were given to the letter. She seems to be able to put her full weight down on her injured leg, and only occasionally lifts it off the ground as if it is causing her some discomfort.
She no longer needs to take the antibiotic Clavaseptic, and the painkiller Pardale-V and her dose of Rimadyl has been cut by half, with Willow taking one tablet twice a day. Throughout the week she hasn't really shown any signs of pain and apart from the first couple of days has been walking on the leg fine, only occasionally lifting it off the ground. The main problem with during the first day or so was the adhesive dressing pulling at the skin, so she may have done better if this had not been used.
Willow resting in her crate
The new calm well behaved Mason
One of the things we were anxious about when considering this kind of surgery was how it would affect both our dogs. Willow would have to spend long periods of time locked in her crate with little exercise, while Mason would be without his fighting buddy and would have to forego his usual daily routine of chasing Willow round the house and wrestling on the carpet. I have been so proud of them both over the last week as they have done far better than I thought they would.
Willow has settled well into her long periods of inactivity, and although we try to keep her mentally stimulated at least with a few games, and open the crate up as much as possible to make a fuss of her and give her attention, I can't imagine that she is too happy. The crate has been a godsend, and I hate to think how we would have coped if we didn't have it. They have never spent too much time in their crate and is used only during our mealtimes, when the dogs are becoming too excitable while play fighting, or if we go out for an hour or so. Before the surgery, we got each dog a memory foam bed for their crate, and in the week leading up to the operation, both dogs would sometimes sleep in their cage by choice with the door wide open.
Mason has really grown up over the past week and apart from going up to see her every now and again, through the bars of the crate, has mostly left her in peace. He has either played on his own or with one of us, and we have tried to include him in the games we set out for Willow. We have duplicated the toys and activities we have been attempting with Willow, so this also keeps Mason occupied and out of trouble. A couple of times Willow has growled a little at Mason as he has approached her crate, but I think that during these times she is just bored and wants to be out and about with him. Over the long hot Summer, Willow became a real outdoor dog and enjoyed sitting on the drive on a seat we have out there. This I think she has missed, as even though the temperatures have dropped significantly, she still wanted to spend extended periods of time outside right up until the time of her operation.
During the first week, there was quite a bit of swelling to the leg, and this didn't start to recede until after around seven days. It is difficult from the images to try and gauge the level of swelling, as this is mainly on the outside section of the leg on the upper and lower thigh down to the hock. I did think it was much better today, almost back to normal, but after having a proper look this afternoon, this is not the case, and there are still signs of inflammation.
The wound looks to be healing well, and the bruising that did appear on the inner leg has mostly gone now, apart from on the knee joint, at the top of where the incision was initially made. This section of the limb is also a little red. We did fear that it was possibly becoming infected, but there were no other symptoms which supported this. Usually with an infection to the wound, along with the red skin, the area will generally be warm to the touch, will have a discharge of pus, and can often have a foul odour. The site of infection also tends to get worse as time goes on, whereas Willow's has stayed pretty much the same since it first appeared a couple of days ago.
The redness may coincidentally be partly due to the cone she is wearing, as we have noticed that when she tries to lick the wound, the edge of the cone rubs in the area in question. It looks worse than it is because of some localised bruising which is also present. The wound has caused Willow a lot of irritation over the last day or so. As well as the stitches tightening, as the skin heals, the fur on the leg has also started to grow back.
Willow has over the past couple of days has also been having some issues with her left ear. This is a little red at the moment and was a bit dirty, but we have been cleaning it out when she comes out of her crate. This could be due to the ears been tucked inside the cone for long periods of time creating a moist environment with little to no airflow. This is the perfect environment for things such as yeast infections so care must be taken if your dog is susceptible to these. This has caused some irritation to Willow, and she wants to shake her head when we are taking her outside, which means that her whole body is moving, putting a bit of extra strain on her poorly leg.
We had a call late yesterday evening from the receptionist at the vets to ask us if we could change our scheduled appointment to today. This was originally due to take place on Friday and was so Willow could have her stitches removed. This wasn't really a problem and thought it would be better for Willow to have these removed sooner than later.
On the day she had the operation, her weight was 18.8 kg. While we were visiting the vets, we thought we would recheck this to make sure she wasn't putting on a load of additional weight from her inactivity. Her weight today was 18.9 kg, so we were quite pleased with that, and the reduction in food during her meals seemed to be helping to keep off the excess pounds.
The vet examined Willow's leg and attempted to gauge the range of movement which she had by flexing and extending the operated knee. He also watched her walk around to check her gait and see if she was using the leg correctly. He seemed happy with her progress and said that we needed to continue restricting her movement, for around another ten to eleven days, by keeping her confined to her crate. After this time we could then start to do a small amount of exercise walking her to the end of the street and back, and then slowly building this up. We have also made an appointment for next Thursday to see a physiotherapist at the vets so she can show us some daily exercises to do with Willow to build up strength and getting the leg back to normal.
I have taken a couple of images of the wound, with the stitches removed. This looks to have healed well, but there are a few areas, namely where the top three stitches were, which are a little red and sore looking. The top part of the wound in particular looks like it may take some time to recover fully. The skin where the incision was made appears very raised at the moment so I hope this eventually sorts itself out once the leg is fully healed. The vet said to keep a close eye on her movement during the next few weeks. He said if an infection does take hold then she will stop using the leg properly, and we need to take her back to the surgery as soon as possible to start her on some strong antibiotics. It was said that often people think that their dog has slightly injured their leg after the operation and don't visit the vet until the infection is more established, which is then more difficult to treat.
Now the stitches have been removed we have switched Willow back to the small protective cone. We did attempt to remove it altogether, but she couldn't resist starting to lick the wound, and we don't want her to aggravate this or cause it to become infected.
Willow is starting to get very bored with being locked in her crate for long periods of time. This morning she was crying for quite a bit wanting to come out. I have started to bring her out of the crate more now, for thirty to forty minutes at a time. Mason has to go into his crate while she is out to prevent the risk of any overexcitement, and she stays on a very short lead while she sits at the side of me. Willow usually just goes to sleep while she is been stroked. I think it is just a big relief to escape for a short time.
Now that we have been able to remove the larger cone/collar, we washed their bedding and moved Willow back into her own crate which she seems to prefer. We have been periodically taking off her Comfy Cone to make her a bit more comfortable but she can't resist starting to have a lick at it and usually ends up back on her after she ignores you when telling her to stop.28 October 2018
You can see better from the images below the raised skin along where the incision was made. This doesn't seem to have changed too much since the stitches were removed, but the top section of the leg, which was very red, looks to have improved quite a bit. The leg doesn't seem to be causing Willow any problems, and she looks like she is putting her full weight on it. Willow is still taking Rimadyl twice a day for pain relief but not sure if this medication is still required as she attempts to pull on the lead when out of her crate and jumps up at things despite our best efforts to minimise this.
It has now been two weeks since Willow's operation. Each day that her leg improves the more frustrated she is with been restricted to her crate for much of the day. We have been trying to increase the amount of time that she is spending out of the container to try and break things up a bit. She has been coming out three or four times throughout the day for around thirty minutes at a time, and on an evening she has a further hour where she generally lays in her basket and gets a big fuss made of her.
Boredom setting in
She has also been spending a little bit of time outside over the past couple of days, to give her a bit of fresh air, and sunshine when it decides to appear. I put her basket on the drive and one of the dog's towels at the side of it for me to sit on. She seemed to enjoy this as she was able to sit there and take in different smells but didn't settle too well as she kept wanting to be off the lead exploring.
Again there has been a little further improvement in the wound, and the ridge of skin perhaps doesn't look so pronounced. From the images, it does look quite red, but if you look at it in real life, it is not quite as intense as this.
Mason spent most of the day at the vets today to have a series of X-rays. He has been having some issues with his front leg and occasionally limps shortly after he has been on a run. We also wanted to have his back joints checked to see if he had the same problems with his cranial cruciate ligament which Willow was experiencing. Thankfully the X-rays didn't show anything abnormal so at least Mason won't have to endure the same kind of corrective procedures as Willow.
Since Mason was not at home, it meant Since Mason was not at home, it meant Willow was able to spend much longer out of her crate than is usually the case. Since it was reasonably cold, I decided to light the fire so Willow was able to spend quite a bit of time sprawled out in front of it, despite the intense heat it was giving off. She was still attached to the lead to stop her wandering off.
I managed to get quite a good look at her leg while she was out and take quite a few photos, a couple of which are shown above. The wound is continuing to improve, and the redness which was found along it has now almost completely gone. The ridge of skin where the scar tissue is forming is also becoming less distinct.
Today was Willow's first physiotherapy session at the vets. We went outside the building and walked Willow up and down a few times so the physiotherapist could look at her movement and how she was using the limb which had undergone surgery. She seemed quite pleased with the results, and although there were signs of muscle atrophy due to its lack of use, her walking largely looked as it did before the operation. The physiotherapist also carefully examine the leg when we had gone back inside feeling the bones and muscles and also watching Willow's reaction to various forces she applied. As well as the muscle wastage which accompanies this type of surgery, her hamstring was also tight. We were given a series of exercises to do with Willow in order to start building up her muscles again and improve further the use of her leg.
We were given the following exercises to do several times each day.
Exercise 1: In this exercise, you put your dog into the sit position, squarely on a non-slip surface, and then get them to stand. This activity consisting of a sit and stand is repeated five times. Your dog may try to cheat and use their nonsurgical back limb to push up with, so their surgical leg should be supported with your hand as you perform this exercise to prevent it from moving to the side. You can use a treat to entice them to do this exercise.
Exercise 2: In this exercise, you have your dog stand squarely on a non-slip surface and then gently lift her front opposite nonsurgical leg off of the ground and hold this up for five seconds. This is repeated five times, stopping if the dog starts to show signs of discomfort.
Exercise 3: In this exercise, you have your dog stand squarely on a non-slip surface, and while supporting their back end you slowly push your dog backwards with your other hand on the chest. This motion puts additional strain on the hind legs, and the position needs to be maintained for around five seconds.
Exercise 4: In the final activity, a piece of cloth is tied lightly on the nonsurgical back leg, and your dog is allowed to walk around on a lead. The purpose of the object on the leg is to irritate your dog so that while walking, there is a tendency to kick the limb to remove it. This action causes a transferal of all weight at the back of the body on to the surgical leg.05 November 2018
It has now been three weeks since Willow had her TPLO surgery but seems like a lifetime ago. Her leg continues to improve daily from a visual perspective, with the ridge of skin around the site of the incision being much less noticeable. We were told by the physiotherapist, that this would reduce naturally as she started to use her leg more and build up muscle mass. As I mentioned before from the photos, Willow's leg looks a little red, but this is misleading and is much less so in real life. She appears to be using the limb normally but has been for some time, and as well as for walking she happily uses it to have a good scratch and push herself up when sitting down. Willow has been continuing with her exercises, but these are sometimes difficult to do as when she is out of her crate she just wants to do anything but these.
We had our first significant setback today. We were told that we could start taking Willow out on short walks while on the lead. When we have been taking her out to the toilet, we often let her have a quick explore of the main driveway so she could stretch her legs, so when she did go out the distance we travelled wasn't really too much further than what she was used to. She was, however, a little excited and was pulling more than usual. Upon returning, she seemed to be walking well and was wondering why she was back home so soon. The problems started later in the day when she was taken into the garden. She had a noticeable limp and was reluctant to put any weight on her back leg, and when stationary, she would hold it in the air. Since having her operation, this was the worse her leg had been, and after only going for a short distance it was a little worrying. We thought that she had just done too much on her walk, so decided to stop her walks for the remainder of the day to rest the leg. We did try to do some of her exercises later in the day, but Willow really didn't want to do these and put any weight onto her poorly limb.
Mason has gone off on some training for six days with my wife to learn how to track, so at least things for the next few days should be a bit easier only having one dog to deal with.07 November 2018
I hoped that after a night resting her leg she would be much better in the morning, and initially, this seemed to be the case. However, when I got her outside, she was still limping quite badly and lifting it when she came to a stop. As she had only gone a short distance yesterday, I decided to call the vet and arranged for her to go in to have it checked out. With the kind of surgery which she had, there are several things with can go wrong in the initial weeks. These can include patella luxation, fracture of the tibia, infections, a loosening of the screws in the bone, and rejection of the plate. While looking into the surgery before the operation, I read part of a study carried out which said that anywhere up to 34% of TLPO surgical procedures are reported to experience some form of complication, with between 2-4% requiring some type of corrective surgery.
When Willow had her meal in the morning, I give her two Rimadyl tablets, which was the dose she was on for the first week following the operation. This additional tablet seemed to help, and within an hour or so she looked a lot more comfortable and was able to move around with only a slight limp.
By the time I had got to the vets her limp had almost gone. I don't know if she was trying to make me into a liar or she was just afraid at being at the surgery again. The vet had a good look at her leg and observed her moving around. She said that everything appeared to alright and Willow showed little to no reaction when manipulating her leg. She advised me to stop doing any exercise and to rest her leg to see if it improved over time. She said if it was still a problem in a couple of days, take her back in with a possible view to having it X-rayed to see if the plate was still in place. While at the vets, I decided to have her weight checked, and this was 18.8 kg which was what she was at the time of the operation.
When I got home, I lit the fire and Willow was asleep in front of it for the rest of the day. When she had her evening meal, I give her a single painkiller, and when taking her out for the toilet, she seemed only to have a very slight limp.
Today Willow seems to be walking normally and is not holding her leg up at all. I was waiting to see what it was like today before deciding if to take her for her physiotherapy later. The vet said yesterday that if she was still showing signs of discomfort then to cancel this and continue resting her leg.
Due to the improvement shown in the condition of her leg, I decided to start walking her again to try and strengthen the muscles in her legs. Rather than taking her down the street where she tends to pull on the lead I just walked her up and down the drive for five minutes before returning her to her crate. Once she had started to build up some muscle mass, I had the intention of walking her outside of the garden again. A little later in the day, there were no signs of limping, so I repeated this around dinner time and just before setting off for her physio at the vets, at 04:00 pm.
In the physiotherapy appointment, I discussed the problem which Willow had over the previous couple of days, and the physiotherapist was happy with the way she was now walking and the fact that she was putting weight onto her surgical leg. She had a good feel of the muscle and said that the hamstring, which was tight before was much better, but did have some concerns with a small section under the scar which was inflamed and a little tender when touched. She advised me to use an ice pack three or four times a day to try and reduce this but also wanted me to get this checked out before I left. Luckily the main surgeon, who had carried out the operation was available, so he had a look at the swelling. He didn't think it was infected but said that three or four weeks after the surgery is one of the prime times when infection can take place. He said that because of the leg improving since yesterday, and the fact that she wasn't in too much pain when manipulating the leg into different positions, infection was unlikely. I was advised to keep a close eye on it and if there was any change for the worse then contact the surgery straight away to get her seen.
I was told to stop the exercises I was given previously, apart from the second one which involved lifting one of Willow's good legs to force her to use her poorly leg for balance. Rather than raising the opposite front leg, I was told to switch to lifting the rear opposite leg instead as this would increase further the additional weight put on the injured limb. I was also to continue with the walks and slowly extend each one from five to ten minutes, three times a day.10 November 2018
I have been taking Willow out walking for around five minutes, three times a day, plus the additional time when she is out for the toilet. Her walking is looking relatively good and is showing little signs of discomfort once she has completed her exercises. To try and reduce the swelling of the scar I am using a gel pad twice a day, which has been in the freezer. I have been using this since the last visit to the vets, but it is difficult to know if this is helping. The physiotherapist mentioned trying to massage the scar as this is supposed to be an effective way to decrease scar tissue build up and help make it less visible. I did some reading up on this, and it said it was best to use some form of lubrication such as baby lotion or bio-oil. I ordered something called Vitamin E Skin Oil which arrived today. You have to be careful when carrying out this type of massage and only attempt to do it when it is safe to do so. If you massage the scar prematurely, you can cause it to reopen or tear, leading the risk of infection.
As part of the body's repair process, new protein fibres in the form of collagen is released around the damaged tissue. The build-up of collagen which results in the scar helps to heal and strengthen the wound. Unlike the original tissue, the new fibres form in a random, inconsistent way which leads to inferior functionality, flexibility and structure. Collagen can continue to grow for several months and is generally accompanied by an increased supply of blood, which causes the scar to become red, raised, and lumpy. Over time, some collagen breaks down at the site of the wound, and the supply of blood gradually reduces. This results in the scar becoming smoother, softer, and paler, but this process can take anywhere up to two years. If there is an excessive overgrowth of tissue around the wound, keloid scars can form. These are raised above the skin and can be itchy and painful.
Scar massage is a method used to remodel the tissue by breaking down and realigning the collagen fibres so that they are more in line with normal healthy tissue. It will be interesting to see if this technique proves to be effective.
We were at the vets again today with Willow for a routine check-up of the leg, which was planned around the time of the operation. He seemed pretty happy with the progress she had made over the first month and how she was using her limb. He had us outside moving up and down the carpark at a trotting speed, while he observed her movement. He also had a good feel of the leg to check that healing was progressing normally. He said that he didn't need to see Willow again for six weeks as long as everything was going well.
Before going to the vets was had a look at several canine hydrotherapy centres which were reasonably close to where we live. This had been mentioned to the physiotherapist, and we agreed that this would be beneficial to Willow to strength the muscles in her legs. Normally, following surgery, the hydrotherapy centre will insist on a referral from a vet, or some documentation to say that it is safe for your pet to carry out this form of exercise. The hydrotherapy centre we selected had a PDF on their website which you could download and print off. We took this with us to the vets, and he was kind enough to spend a little time filling this in.
While at the vets, we did ask about the plan for having the operation on her right leg. He said this would probably be ready to be carried out early in the New Year.
In most cases of TPLO surgery, I have read about, after several weeks following the operation, the leg is X-rayed again to make sure that the bone is fully healed, however, the vet said that this wouldn't be necessary and if there were any complications then this would be clearly visible when she was trying to walk. I'm quite pleased about this really as there is always a risk during sedation or anaesthesia, which is required for the X-rays. Although veterinary anaesthesia has become much safer thanks to better protocols, safer drugs and sophisticated monitoring, the death rate for dogs is still around 0.15% on average. Some dogs are more at risk because of their age, if they are suffering from an illness or if the duration of the anaesthesia is over a long period.