TPLO – A Sarah Saga Cont’d.

Update June 23rd. I found this site just yesterday which argues for a non-surgical fix for a CCL rupture. It is a very thorough, well-researched site that I probably wish I’d seen prior to making the decision to allow Sarah to have the TPLO surgery. I don’t know if reading what this site provides would have made any difference at all in my and David’s decision to have Sarah go under the knife. But, the site is informative–if not in a few places a little cynical–and is a good read for those who face a CCL repair for their dogs.

Not wanting to be pedantic with this post, but hoping it might be helpful to dog owners who are or will be going through this onerous exercise. I’m told Cranial Cruciate Ligament rupture (in humans this is generally referred to as an ACL injury) is a very common ailment with dogs, and recognizing the signs as well as understanding the fix is important.

The prior post on the subject of Tibial Plateau Leveling Osteotomy (TPLO) surgery is here. This surgery is performed when a Cranial Cruciate Ligament (CCL) rupture is detected by a vet. Simply put, a CCL injury allows the femur to slide on the tibial slope and reposition the base of the tibia on the top of the femur unnaturally.

It is now a week after Sarah’s TPLO surgery. She will get her staples out today. Suffice it to say, she is getting more than a little weary having to wear her Elizabethan collar. But, then, that’s a hell of an incision that requires protection from licking or biting. Remember, the mouth contains some nasty bacteria and infection is something one doesn’t need to contend with besides recovery from the surgery. Besides the collar, Sarah is further restricted to the house and occasional visits to the back yard; no more than navigating two steps and walkies of not more than ten minutes. She still has a perceptible limp and is still reluctant to put much weight on that right leg. The limp, however, is significantly less severe than before the surgery.

The x-ray photo shows the pre and post-op positioning of the bottom of her femur on the top of her tibia (the plateau). The pre-op picture shows a 26% deviation from normal positioning. The post-op photo shows a 7% deviation. Quite a change. The ideal surgical positioning is, I’ve read, 5%.

Several lessons have been learned through this saga.

As I noted in the prior post, I took Sarah to her regular vet twice and to the emergency hospital once because of her debilitating limp and it wasn’t until the third vet visit that it was suggested Sarah see a surgeon. I provided during that third visit (with her regular vet) a video of Sarah’s morning, tortured walkie, clearly capturing the horrible limp and her reluctance to place any weight on the affected leg. It was the video that convinced her vet to recommend a surgeon.

First lesson learned: If you dog sustains a limp on a back leg for what you feel is an inordinately lengthy amount of time and if your dog avoids placing weight on that leg then beware. It may be CCL and the sooner that is confirmed the better. Now, that first lesson is that the word “limp” to describe your dog’s condition should be replaced with the word “lameness.” It seems that vets place the word “lame” in a higher category of concern than the word limp. Indeed, even after the visit to the emergency hospital where they took x-rays of Sarha’s pelvis and legs, the diagnosis was incidental arthritis. And, it was through all of the three vet visits before going to the surgeon, I used the word “limp.”

Second lesson learned. When I took Sarah to the emergency hospital, we were sent home with Deramaxx, an anti-inflammatory, and Tramadol, a pain medication. Not long after I put Sarah on these medications, she lost her appetite and began having squirty diarrhea. It was then I took her for her second visit with her regular vet who provided an anti-diarrheal med. The loss of appetite and diarrhea continued. It was at that vet visit that a surgeon was suggested.

I was lucky to get into see a surgeon not more than three days after that vet visit. In the meantime, I took her off all her meds. Something told me that it was the medication causing the loss of appetite and diarrhea. Yeah, DUH! Good thinking, George.

The surgeon was an old guy with more than thirty years of experience as a vet and surgeon. Almost immediately he diagnosed CCL…something not found by the other two vets who examined Sarah (he confirmed CCL with an x-ray). He then asked about the meds Sarah was on. I told him Deramaxx and Tramadol. I then related that she had lost her appetite and had consistent diarrhea. “Oh,” he said, “take her off the Tramadol. That’s causing the problem. But, put her back on the Deramaxx.” The old guy was right on. It was the Tramadol causing side effects which, if you read the literature on the drug, includes inappetence and diarrhea.

So, second lesson learned: Be aware of the side effects of the meds prescribed for this condition (any condition). That’s our responsibility as caretakers of our dogs.

Thursday, two weeks ago, I dropped Sarah off at the hospital at 7 a.m. I picked her up at 10 a.m. the following day. She was walking on the affected leg and was quite loopy from the lingering effects of the anesthesia and pain meds, including a Duragesic (fentanyl) transdermal patch they had put on her side to control pain. She was zonked out most of the first day back at home. The second day back home, I let her out in the back yard and she began pacing the entire yard, very anxious, almost paranoid behavior. She kept sniffing at the air and scanning every corner of yard as she paced back and forth and back and forth. This wasn’t good. Her activity level was supposed to be severely restricted. Once I got her back in the house, I called the old doc who had done the surgery and explained Sarah’s behavior to him. “Does she still have that fentanyl patch on her? If so, that’s causing her to be crazy and you need to just rip that thing off.” Once again, the old doc was right.

I recall that before Sarah was released back to me at the hospital, the vet tech warned that when I removed the fentanyl patch in four days as instructed, I needed to fold the patch over on itself, place it in a plastic bag and dispose of “securely.”

Fentanyl is 81 times more potent than morphine. It is a controlled substance. And, once I thought about it, when I took Sarah to the emergency hospital (where she was diagnosed with incidental arthritis), they gave her morphine in order to splay her legs and get a good x-ray of her pelvis and legs. Once I got her home from that ordeal, yes, she exhibited the same spooky behavior she did the second day after her surgery. The light bulb popped on: Sarah cannot tolerate opiate analgesics. They make her–as the old doc said–crazy.

This, of course, was the third lesson learned.

During Sarah’s first week at home after the surgery, she would literally scream (Malamutes are very vocal) whenever she stood up or lay down. So, I called the old doc again. We discussed her intolerance of Tramadol and he prescribed Acepromazine, a mild sedative that folks who travel with their dogs are surely aware of. And, once again, the old doc came through. The Acepromazine kept her half loopy and did, somewhat, ease the pain of standing up and laying down.

Fourth lesson learned: The old guys/gals who have practiced veterinarian medicine for more years than some of you have been alive, are worth their weight in gold. Not that I fault Sarah’s regular vet. She was, after all, the one who concluded Sarah needed to see a surgeon. I do fault the emergency hospital vet who, even after x-rays and a thorough exam did not recognize a case of CCL.

So, today Sarah will get her staples out. In 24 hours I can remove her Elizabethan hood for good. She has already had her first rehab session. She will not get another x-ray of her leg–to see if the surgery “took”– until four more weeks. If all is well at that time, her activity level can increase and, hopefully, we’ll be on our way to a full recovery. There is, I was told by the rehab folks, a 50/50 chance her other leg may experience a CCL rupture. Ugh! Prayers, I guess are the only defense against such a horrible prospect.

One other thing. Sarah has refused to eat her normal dog food for quite some time. The only thing she will eat right now is Primo Taglio Pan Roasted Turkey (at $8.50 a pound), and thin pork chops. She will occasionally eat a Milk Bone type cookie, and still enjoys an occasional Bagonstrip. Probably one of the hardest recovery exercises David and I will have to make is to get her back on her normal doggie diet.

So, that’s the story up till now. I hope to post about further developments. And, I hope what I’ve provided is helpful/informative to those who are experiencing or about to experience this same saga with their own dog.

This has not been a cakewalk. And, we’ve got a long way to go. But, of course, for Sarah David and I will, without question or second thoughts, do what needs to be done.

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24 Responses to TPLO – A Sarah Saga Cont’d.

  1. Drunkbunny says:

    So sorry about Sarah and I hope she recovers fully and soon! I’m impressed that the surgeon even tried Fentanyl pain control. So many vets don’t do any post op pain control past day 1 post op for these poor dogs.

    I’ll be disappointed if the emergency vet you took your dog to was Alameda East, because I think they are the best. I went to the emergency vet by my house once and they are stupider than a box of rocks (I used to be a vet assistant at an emergency vet so I feel I can say that). I knew right then that if Moose ever needed emergency care I’d drive all the way to Alameda East and skip the local emergency vets.

  2. georgeindenver says:

    Not Alameda East, DB. Thanks for your kind comments.

    The emergency vet is with the same group where her surgeon practices. I’ve been so impressed with her surgeon–even giving out his cell number which he actually answered himself! every time I called!–that I’m reluctant to name the hospital group.

    I actually called Alameda East before settling on the surgeon who took care of Sarah. They had only one orthopedic surgeon available then and they noted it would be a while before Sarah could be seen.

    So, so far, everything is working out pretty well. Just hoping the prognosis (after the sixth week x-ray) bodes well for her full recovery.

    George

  3. Valerie says:

    Hi George,

    Been reading about Sarah.. how is she now? Is she fully recovered? My lil girl (a Golden Retriever) is facing this surgery very soon for both knees at the same time. How did you manage to keep your Sarah from jumping and getting excited and running around? Any practical advise would be appreciated.

    Thanks..

    Sad Doggie Mom in CA

  4. Louise says:

    Valerie,

    Our 1 year old mastiff had both knees done with a gap of 4 weeks between each op. She’s a very bouncy bubbly girl and the idea of keeping her calm really worried me.

    Given that she walked out of the Vets unaided, and had no issues walking at any stage it’s been much less stressful than I’d thought it would be.

    For the week after each op she was so groggy that it really wasn’t an issue, she slept. A lot. Then she was a little unsteady on her back legs so didn’t really try to jump too much.

    Beyond that time she seemed to be getting bored.

    I tried (and still am trying – lol) to teach her left and right, and to nod. Not sucessful in training terms, but it created interactive time for her. Lots of grooming, and puzzel toys and chews were great to distract her when she started getting over excited. She was basically grounded to our front room (which is really quite small) for 7 weeks, and so got into the habit of not running about.

    She’s made it to 10 weeks after the second op and has been doing well right from the start.

    I hope all is well with your girl and that you find it as easy as we have.

    Good luck

  5. Valerie says:

    Louise,

    Thank you for your kind response. It does help alot. I took our Maggie Mae to the surgeon and he said that she does need the bilateral TPLO but he won’t do both at the same time because of how difficult it can be for the dog in the healing process.. so he will do them 6 weeks apart. I’m still concerned about keeping her apart from her “family”.. the other three Goldens that we have, but we made the decision to trade sleeping quarters with my son so we won’t have to deal with getting her up and down the stairs to our bedroom. 12 weeks is a long time but to give her the chance of not having any additional issues it is a small sacrifice. Her first surgery is August 14th. Your note has sure helped to relive some of my fears. Thanks so much! I hope your girl continues to improve. Amazing how much you just want to see them run, jump and play again!
    Best Wishes.

  6. Valerie says:

    Hi George,

    I updated my blog.. how is Sarah? Maggie is doing great. We haven’t done the second leg as yet.. we don’t have the money now.. but she seems to have no pain or lameness which is a good sign. Maggie has passed her 15th week! You can’t tell she ever had the surgery and she is as fiesty as ever and still commands dominance over the other three dogs. She is a charactor. This experience has bonded me more closely to her. She is rarely five feet from me at all times.

    Best to you and your family this holiday season!

    Valerie

  7. georgeindenver says:

    Hey, Valerie

    So good to hear about Maggie’s progress. Got to observe that if she has no pain or lameness in her other leg, begs the question if there is an CCL issue with that leg. And, yes, the fact she’s not exhibiting the telltale signs of CCL in the other leg is heartening, wonderful.

    Sarah is doing great. I’m sure new bone growth has occurred, and she is certainly back to “normal.” As is the want of Alaskan Malamutes, she is very, very strong and has returned to the pulling behavior that characterized her “personality” prior to the onset of CCL. She is well-behaved and does respond to commands, but still the pulling behavior has come back which, having gone through the CCL saga, is kind of a gift: we got our little girl back.

    I have noticed a couple things, however. When she is prone on her tummy, she keeps the TPLO leg stuck out straight, not bent under her. I’ve also noticed a very, very slight inward turn of her right rear paw when she walks. She has a very fluid, easy gait. But, again, that inward turn of the paw is noticeable. Last thing, I’ve noticed that, at times, when climbing stairs, she will drag that right rear leg and stumble slightly, but she quickly recovers. So, only conclusion is that the affected leg is slightly stiff. Small price to pay for, again, getting our little girl back.

    Thanks so much for the update, Valerie.

    George

  8. Deb says:

    My Siberian is scheduled for TPLO next week. My questions is for those of you who have had TPLO sugery on your dogs did you have the plates and screws taken out after the bone healing?

    I’ve heard there is the possibility of cancer at the plate. Additionally I’ve read about complications with the screws coming loose after the healing or screws breaking off. I’ve also read of infection at the plate and or screw site months after bone healing.

    The surgeon we are working with quickly explained that taking the plate out is something to think about due to the possiblity of cancer, but quickly said nothing has been confirmed medically so he didn’t recommend it as necessary.

    • georgeindenver says:

      Deb: Have never heard the concerns you express about cancer at the site of the plate. And, no, it would be absurd to take out the screws and plates after the healing. As a matter of fact, I suspect the healing process has relegated the screws and plates as part of the essential anatomy of the dog. To remove them would be ludicrous. Why would you want a surgeon to go in again, thus causing your dog another three to six months of pain and healing? Have had no issues with infection, breaking off of the screws or really anything you’ve mentioned in your comment. I believe, perhaps understandably, you’re just experiencing what every other pet owner/lover experiences upon the prospect of surgery for their beloved baby: fear of the unknown. We’ve all gone through it. And, for us, the experience has given our precious baby back to us…completely cured, completely healthy…no cancer, nothing untoward as a result of the surgery.

      • Deb says:

        Surgery went well she had a pre op 33 degree angle and bone twist. Post op is a 9 dergee angle (we were told 6 degrees is optimum). After 8 weeks post op she has healed perfectly. Our strict 8 week confinment after surgery worked!

        I would disagree with the statement regarding removing the plates and screws – “to remove them would be ludicrous.” We talked to the surgeon and a vet. Both concured and said if you were going to do something else at a later date, such as the other leg needed TPLO or you were going to sedate for teeth cleaning – then if you wanted to take the plates and screws out it would be a reasonable decision. The surgeon, who has done the most TPLO surgries in the Pacific Northest said he would take the plates and screw out of his own dog if there was a sedation needed for something else at a date after healing had completed.

        Regardless we are happy with the TPLO results. We are 10 weeks post op – our siberian is so proud to be able to take short leash walks. She really struts, prances and keeps that tail up much more than she ever used to. We tried the let her heal without surgery for 4 weeks. It became clear that while her scar tissue would rebuild every time she did normal doggie things it would break down and need to build up again. That was not going to be a quality of life we wanted for our 4 year old dog – well any age dog for that matter. I am of the opinion that whle there are risks with TPLO surgery it is the way to go.

  9. Liz says:

    Please consider NOT doing the TPLO if your dog has torn its cranial cruciate ligament (also known as ACL). This surgery is wrought with problems. Dogs can heal conservatively (without surgery) despite what many vets may say!

    • Deb says:

      I think you should consider all options if your dog has a torn cranial cruciate ligament. T

      After my dog was seen by two vets, a surgeon and talking to many people who had the same experience I made the decision to have TPLO surgery done.

      Your dog will build up scar tissue around the knee if you let it heal conservatively. This will keep everything “in place”; if your dog will lay around your house or lawn all day, then this will be an acceptable option. If your dog is active each “normal” doggie activity will break that scar tissue down. Then the scar tissue will need to be built back up. This means keeping your dog inactive for a while. This process will happen over and over and your dog will likely end up with a rather large knee because of the continued building up and tearing down of scar tissue. While the large knee doesn’t hurt the dog it looks terrible and your dog really never gets back to a “normal” activity level. You will need to either keep them inactive, or have rest periods after activity to build that scar tissue back up.

      TPLO was the best option for my dog. Our dogs are active and I wanted them to have the best chance at continuing that activity. I knew there were things that could go horribly wrong with any surgery, but the gain outweighed the risk.

      Each individual can choose what works best for their dog. I(Isn’t America great) I think it is insensative for anyone to say you must choose a consertative method, or you must choose TPLO. Do your research and feel good about the decision you make. Give your suggesions and experiences to others but don’t make them feel insiginificant for choosing an option different from the one you may have made.

  10. georgeindenver says:

    Sorry Liz, can’t agree. My series of posts with regard to this procedure, and the remarkable result of making our Sarah “whole” once again after recovery, is testament that this surgery does work. I would not hesitate to have it done again, if her other leg goes “bad.” I suspect your “…wrought with problems…” comment has more to do with inept surgeons, rather than the procedure itself. Dog owners can, of course, make their own decisions about what’s in the best interests of their pets. I know I made the right decision.

    Be well, George

  11. georgeindenver says:

    Thanks Deb for straightening me out with regard to the later removal of the screws and plates. I shouldn’t have assumed the role of “surgeon” with regard to this issue. Thanks also for your reasoned comments on the worth of TPLO.

    I do have to say, however, I won’t be having Sarah’s screws and plates removed. Just don’t want to go through another traumatic moment (days, weeks) with this thing. Also, it is a curiosity the surgeon who did Sarah’s TPLO (36 years wielding a scalpel, thousands of TPLO surgeries) didn’t even mention the removal of the screws and plates. Of course, I didn’t ask the question.

    Anyway, thanks again.

    George

    • debbie stupur says:

      Unfortunately our siberian had to have TPLO on her second knee. I choose to not have the plate and screws from the first TPLO removed. Thank you George for your candid thoughts about this choice.

      I am pleased to report we are a couple years post op and Maya is running 2-6 miles with my husband and I. The surgeon said he felt it was fine to let her run/jog with us if we don’t push her…she loves it and goes crazy when she sees the running clothes and shoes being put on.

      TPLO was the best choice we could have made. (If you choose TPLO please be diligent in keeping your dog confined during post op.) Our siberian Maya has been given back the quality of life she deserves.

  12. Maggie says:

    Hi George, thanks for your blog. It is great to hear other stories (especially sucessful ones)!

    My Bullmastiff/Brisish Bull Dog Cross is 5 days into recovery of his second TPLO surgery. He had his left leg done at about 9 months, and recovered amazingly well, but then ruptured his right CCL about 12 months.

    I have done so much research and spoken to so many people who have delt with the same issues and I agree that TPLO is a fantastic option.

    You can leave the dog to heal it’s self, but it will most likley rupture the CCL again at a later date, unless you keep it’s activity severly restricted for life (ie no running round and having fun), and the dog will most likley suffer from quite serious athritus.

    Our surgeon specializes in this surgery, and recomends leaving all the titanium in the dog. There is still a good chance there will be some arthritus in the knee joint, but not nearly as bad as if we just chose not to have the surgery.

    Dozer is feeling so great after 5 days, it’s going to be a long recovery process keeping him quiet!!

  13. georgeindenver says:

    Maggie: Thanks so much for your comment. And, God Bless Dozer! So good to hear he’s doing well. Can’t imagine the ordeal of going through another surgery. But, of course, I think every experienced surgeon will warn that there is a good possibility if one rupture occurs, chances are pretty good the other one will do the same. Thankful that Sarah has not yet shown any signs of the telltale limping and weakness on her “good” leg. As to arthritis… Suspect most dogs will, eventually, experience some arthritis in varying degrees of severity as they grow older. I know all of my dogs–and, lordy, I’ve raised so many!–have all shown signs of arthritis as they’ve aged. Just like most people. (I’m going through that myself, these days. UGH!)

    Anyway, so glad to hear about Dozer.

    George

  14. Laura says:

    Our lab/chow had TPLO done on both knees 11 days ago and she is doing awesome! We put off doing the surgery since it was so scary. After surviving the first night I recommend to anyone having this done to pay to keep your dog in the vet hospital the first night! What a nightmare. She was really freaked out. But now she is really adjusted and can walk better on two knitted legs than on her original legs!
    YES!
    I would recommend this surgery to anyone that has money to pay for it.

    • georgeindenver says:

      Hooray! Laura So happy your baby is doing well. I’m wondering if the “…freaked out…” experience that first night might have had more to do with the drug, Fentanyl, than with anything else. This is a very powerful morphine-like drug, used to control pain. Sarah was on it for a day or two after surgery, and her behavior was absolutely weird, freaky. As soon as we removed the Fentanyl patch, she settled down and was able to rest and recover. Once again, good to hear this happy news.

  15. AbbysDaddy says:

    Hi All,
    I just got done reading this and it makes me so happy to hear about successful outcomes from TPLO surgery. I myself am coming to the conclusion that my 7 year old Belgian Malinois need TPLO surgery on her right leg. She hurt it back in August and we kind of hoped that if we restricted her from activity she would heal on her own. No stairs, no running, no jumping and no playing..But once that stupid doorbell rings she is the first to jump up and bam we start all over. So here I am asking for some advice from the people who have dealt with this. I agree with discouraging posting names and address of surgeons or vet clinics that do this, but if any of you could send me an email of who they used and the outcome that would be great. I live in aurora and have look at 2 places Alameda East and Colorado Canine Orthopedics is the springs. And info on price or vet you recommend would be so helpful because it break my heart to see my Abby go through such pain.
    Thank you all
    Tim
    abby.cujo.steeves@gmail.com

  16. Laura Kurk says:

    Hello TPLO survivors–Our border collie claire is one week out from tPLO on her right leg and this morning, when I was careless and let her out to potty off -leash, she got cocky, twisted, and ruptured her ACL in her left knee. She dropped in pain immediately. ARRGGGHHH….I feel so awful. Because we are only one week out from the first TPLO, our vet feels like our surgeon will not want to do the second soon. The problem is, she is now really completely lame. She has not urinated since before the tear episode this morning. I try supporting her back end so she’ll potty but she drops down crying. Any advice on how to accomplish the potty problem? We’re really at our wit’s end.
    Thanks all!
    Laura

  17. georgeindenver says:

    Laura, I’m so, so sorry for your misfortune. Lord knows one TPLO at a time is quite enough. Border collies are so active, so “hyper.” (I’m remembering now Jon Katz’s, “A Dog Year.”) I am at a loss how to solve the potty issue. The only thing that comes to mind is supporting the abdomen with a towel or sheet, taking the weight off the back legs and just walking around the yard with Claire. Dogs are so adaptable. I really think Claire will figure it out…probably sooner than later. I’m wondering if you’re on Face Book? There are several Border Collie owners’ sites on Face Book, one of which “Border Collie Appreciation Group,” that has nearly 5,000 members. If you’re not on FB, I’ll join the Border Collie site and present your question/dilemma to them. I’m a member of the Alaskan Malamute site and it has proved very, very informative. Additionally, I’m wondering if you should speak to the surgeon him/herself to access the possibility of another TPLO now. I’m remembering that Sarah was not completely lame on the site of the surgery. Yes, it was very important to keep her quiet and calmed down for more weeks than I want to remember, but I don’t think she was absolutely immobile on the affected leg. Sincerely hoping you can resolve this as soon as possible. It’s so hard to see our children suffer.

  18. Wendy says:

    “This site” link appears to be broken. Any chance of an update to that info? My dog apparently needs TPLO and I am trying to make good decisions for her. Thanks!

    • georgeindenver says:

      Sorry Wendy, I can’t find the original link. As I recall, it was a personal story about several months worth of restricting a dog showing signs of a CCL injury to very low activity levels. I recall the story claimed some success with that. My experience, however, having gone through three TPLOs with two dogs, is that the surgery works well. The recovery period is the worst part of the process, but the end result is well worth it. I suspect if you Google “non-surgical CCL treatments” you’ll get some good information.

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