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.