Wednesday, April 21, 2010

Surviving The Post-Op: After Your Dog's ACL Surgery

You're probably all worried, I was too. Let me start with the good news. Based on my experience with Jasmine's bi-lateral ACL surgeries I truly believe that the post-op recovery is actually going to be much easier for your dog than it will be for you.

Dogs are survivors. They don't sulk or complain, they take what there is and make the best of it. They have an amazing ability to adapt and make things work. This is probably one of the times when the difference between a dog and a human attitude is the most profound.

The other good news is that from the moment of the surgery your dog is on his way to get well. That's what I kept telling Jasmine--and more importantly myself--when I was counting the days. You are one day closer to getting your life back. And then two …

Prepare your home

It will make it easier on both you and your dog if you plan ahead and get some things ready before the surgery. Of course if you have a little dog some of the points below won't apply, because you can simply carry your dog around. However, large breed dogs are more likely to suffer an ACL injury.

After your dog comes home, you will have to restrict his movement. Prepare a comfortable and safe place for your dog, ideally somewhere near you.

He will not be allowed to use stairs. This means he will be restricted to the main floor for some time. Think how you're going to make this work so your dog is excluded from your life as little as possible. Good spirits are important for physical healing.

We dealt with that by moving all our activity to the main floor, and because our bedrooms are on the second floor, I slept with Jasmine in the kitchen. Clearly you don't have to go to the same extreme, but whatever you're going to do, have it figured out before hand.

Slippery surfaces can be a danger to your dog after the surgery. You can assist your dog when walking on them, or you can do what we did--buy some cheap carpets and rugs and cover the entire main floor. Problem solved.

Are there a couple of stairs on the way to his potty place? Again, you can assist your dog by supporting him with a towel (towel-walking) or, if you have the means, you can build a simple ramp. Jasmine didn't like the idea of towel-walking at all. She would either freeze or move awkwardly backwards – clearly not very helpful when trying to assist her up and down the steps. She did however love her ramp. We also covered it with an outdoor rug to make a safe non-slippery surface.

If getting a ramp, make sure it's comfortably wide and with a very mild incline for safety (which means it will need to be fairly long as well).

Prepare your dog

If you never tried towel-walking your dog before, you might want to try and see how he responds to it. Place a towel under his belly and support his weight when walking. There are also some cool products designed for this purpose. In any case, I think it's a good idea to have this figured out before hand also.

Prepare yourself

The post-op is going to be quite similar regardless of which surgery you choose for your dog. It will be a long  journey. Seeing the light at the end of the tunnel is what will help you to get through it.

Prepare yourself for a visual shock. When your dog comes back home, his leg will be shaved, bruised and with a long incision. He might be quite spaced out from the surgery and from the meds. When Jasmine came home, her eyes looked quite bewildered. He will be using the leg very little or not at all.

Do your best to make him comfortable. Plenty of deep sleep is important for the healing process.

Have your vet explain the post-op rehabilitation to you in detail. You will probably get a printed sheet – read it and ask questions until you understand everything you need to do.

Taking care of the incision

Keep an eye on the incision. Make sure it remains dry and clean, do not allow your dog to lick it. This can lead to infections and neither you or your dog need the additional trouble. The incision shouldn't be bleeding or oozing.

TIP: We found that Preparation H (yes, the hemorrhoid ointment) works wonders in promoting faster deep wound healing. 

The PROM is not a party

Passive Range of Motion exercise (PROM) is an important part of your dog's post-op program. It is a flexing and stretching exercise that promotes joint health, prevents contraction of the muscles and stimulates blood and lymphatic flow.

However, there is a good chance your dog won't like it at all. Have your veterinarian show you how to do the exercise properly. I recommend you consider muzzling your dog for the exercise (simple cloth muzzle works fine).

Don't use force. If the joint is too painful to do the exercise, consult your veterinarian about pain management.



Bringing it home

Safety is the most important part of the post-op period. Do everything you can to prevent any mishaps. One bad slip or one bad jump of the couch can be disastrous.

Follow your dog's post-op schedule religiously. The better you do with that, the better and faster will your dog recover.

Figure out ways of entertaining your dog during his restricted exercise period. Try some clicker training. Get a lot of yummy chew toys. You can even try some dog companion videos, such as the ones by Stanley Coren.

It will feel like a lifetime. But that too shall pass.

Wishing your dog perfect recovery
Jana

Related articles:
Talk To Me About ACL Injuries
Preventing ACL Injuries In Dogs
ACL Injuries In Dogs: Xena's Story 
ACL Injury Conservative Management: Sandy's Story
Don't Forget the Physical Therapy
ACL Injuries in Dogs: Non-Surgical Alternatives?

37 comments:

  1. Great article! I recommend using a canine-trained physical therapist to adjunct the post-op care with ROM, massage, laser and other techniques for maximum healing and results. Thanks, Susan Davis, PT

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  2. Susan, thank you for reading, glad you like!

    Seeing a therapist wouldn't have worked out for us with Jasmine's ACLs at the time, since the risk associated with traveling was higher than the benefit would have been, plus had other things on her plate. Our surgeon did show us how to do things properly.

    Later, with Jasmine's muscle injury, we were seeing a vet chiro for underwater treadmill and other treatments.

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  3. just a quick follow-up--I understand your point about travel, which is why I provide PT in the home. It is a great practice model, except that I obviously cannot provide water therapy. Underwater treadmill and canine swim facilitites are so great 2 months or so after surgey. I am so glad Jasmine has recovered!

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  4. Susan, that is the perfect scenario! (PT in the home)

    Jasmine is doing quite great, her knees are solid and her arthritis not bothering her at all thanks to the stem cell treatment she got also.

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  5. I like icing too. Just for a few minutes twice a day and keep the wound dry. Nice article Jana.

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  6. Thanks for this detailed article! I am bringing my dog back home from her ACL surgery today and I'm anxious about what to expect and how to prepare the house. This was really helpful!

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    Replies
    1. Glad you found this helpful! Glad the surgery went well, which one did you dog have?

      Did you get a detail post-op plan from your vet/surgeon? If not, please ask, or discuss the example post-op plan I have also posted.

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    2. She had the tightrope procedure. Our vet says he does at least one of these every week! We're hoping the other knee holds up - she's only 3 years old!

      I found a different post-op plan online and reviewed that with my vet http://www.cvahonline.com/home-care.html

      I'll compare it with yours - can never have too much info on this stuff! We bring her back in 3 days for a checkup.

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    3. I'd be very interested in updates, as I don't know any dogs who had this particular surgery.

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    4. We're 2 and a half weeks post-op for the tightrope surgery on our 3 year old lab/husky mix, and she just got the stitches out. She's been getting laser treatments to help speed up the healing, starting with twice per week, and now once per week.

      We brought her home the day after the tightrope surgery and she looked great - no bruising or anything. But the next morning when we let her out of her crate, she got so excited she jumped and bruised her knee. But, when we brought her back in for her 3 day checkup, they did the laser treatment and by the next morning the bruising and swelling was almost completely gone! I can't say enough good things about the laser treatments.

      She's been putting partial weight on her leg from day 1, but every so often (usually when we take her into the waiting room at the vet's) she tries to jump and causes some swelling. That has made her recovery take longer, but the swelling finally went down enough to take the stitches out and get rid of the cone!

      She's putting a little more weight on the leg, but definitely nowhere near what she was before the injury. We'll be starting short leash walks soon, so far it's just been out to the yard on a leash to potty.

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    5. Cold laser is certainly awesome for many things. Glad the surgery went well. The recovery does take time, just think how much healing there needs to happen to the knee and to the soft tissues around it and all. Lot of work for the body.

      This is one of the things that need time.

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  7. Wish I had found your site before Zeb's op. However, he has had the op today and your article is helping me to relax a little bit. The positive slant is really helping.

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    Replies
    1. Glad you found my article helpful. I have a number of cruciate articles on the blog, if you do a search.

      Which surgery did Zeb have? Glad it went well. Do ask your surgeon for a detailed post-op rehabilitation plan, as that is as important as the surgery itself.

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  8. Our westie had Cruciate surgery yesterday. She is rightly feeling sorry for herself at the moment.
    She hasn't been to the bathroom and I am not sure if this is because she cannot squat as the surgery was on her back leg?
    Has anyone else experienced this post surgery with their dog and any tips??

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    Replies
    1. She hasn't been to the bathroom - please explain
      a) hasn't gone outside at all
      b) hasn't peed
      c) hasn't pooped

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  9. Great article. We just brought home our 86LB pit/bulldog mix. He is only 14 months and already needs acl surgery on both knees. His TPLO surgery went great yesterday and the vet is very positive. I was not very prepared for the look and inability to hold the leg. Since he is so young and soft bones he has a split which will be changed in 5 days. Taking him outside was very traumatic. We tried the towel sling and he had trouble peeing. I can right in and ordered a harness from handicapped pets. I hope it arrives soon and figured since he needed the surgery later on the other leg this would help out.

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  10. My Tibetan terrier has just had a TPLO surgery and came home 2 days ago but hasn't been for a poo yet , maybe it's because she's on a bland diet of fish /rice/chicken/pasta or maybe cos she is scared to go for the discomfort she is in. Can anyone tell me how long it normally takes fir them to go?
    Ps great tips for post surgery.

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    Replies
    1. If it's been two days I would start worrying. Jasmine would also not poo for a while after each of her surgeries, mostly because she didn't eat at the vets at all. But this is getting to be a bit long.

      No, I don't think it should be because of physical problem with going, or fear from going. She does squat to pee, right? Not that much of the difference, physically.

      So I'd talk to your vet, you want to avoid constipation and you do need to get the poop going.

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  11. My 4 yr old lab is having ACL surgery on Wednesday. My question is when you brought your animals home how did you get them out of the car? Did you need 2 people? My vet also isn't putting a cone on her. I think that's great BUT I don't want her to lick her wound. I bought a blow up one just in case. Any help would be great!

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    1. We had a truck, hubby was able to lift her in by himself. Our vet offered assistance, though.

      How much help your dog will need depends on the type of car (how high it is etc)

      We didn't use a cone either, I work at home and was able to watch her to make sure she leaves the incision alone. If she didn't, we would have to use something.

      There are other products out there now, more comfortable to the dog than the cone, too.

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    2. Note: since you still have time, you can consider getting a ramp, or PickMeUp Harness, or Bottoms Up Leash. Very helpful.

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  12. My 7yr old staffie had cruciate repair op on back left leg. He was feeling extremely sorry for himself and was back to normal on 3rd day. Bruising has appeared on day 3 tho and im wondering if thats normal? Does anyone know.....

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    Replies
    1. Are you sure the bruising appeared? Or is it that you first noticed it? Because bruises change colors over time.

      There will be swelling and bruising post op. Unless the incision is angry and oozing, you're likely looking at normal part of the process.

      If you are concerned, you can always take some photos and send them to you vet/surgeon

      TPLO Recovery: What You And Your Dog Can Expect


      My Big Operation by Simon

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  13. Our 5 year old Rottweiler, Snot, had the tightrope procedure done 3 weeks ago. Now, he's being super stubborn and just holding his leg up...do you have any tips/tricks to help him understand that he can use his leg again?

    He lets me do the range of motion, put ice and heat on it, doesn't show any discomfort when I touch it. His last appt the vet said his knee was nice and strong.

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    Replies
    1. I am hesitant to buy that he's just being stubborn. I feel that if he's not using the leg, he has a good reason for it. Truly.

      I'd go searching for what that reason is.

      Has he been using the leg at all post op? At least toe-touching? Or has he not been using it at all the whole time?

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  14. I have a pet dog also. I think this article will be a big help for me.

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  15. Thank you for all the advice! The towel walking is a great technique that helps a lot...and yeah I didn't even think about rugs for slippery surface thank goodness you mentioned that! Great that you post about these things. It's hard for dogs and owners and making the dog more comfortable and relaxed will definitely aid the healing process.

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    Replies
    1. Glad the towel walking worked for you, Jasmine didn't like it very much. But many dogs take well to it.

      Taking care of anything slippery is a great help. These days, you could also try the ToeGrips, which help a lot as well.

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  16. Thanks for the advice. Biscuit my Mini Schnauzer had a fall and fractured her knee and severed her ACL. She has had it replaced. Today is day 4 post op. She won't walk on the injured leg. Looks like she is in pain constantly but still will make effort to come for food. I tell her to stop licking her wound which she does but I am not there during the day, so will speak to vet about cone. Feel sad for her to have a cone as well as everything else she is going through....How long was recovery for you?

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    Replies
    1. Poor girl. Talk to your vet about adequate pain management. The fact she's not walking on it this early is not a surprise, though.

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    2. My cat just has surgery to repair three snapped ligaments (this morning). She looks like she is in so much pain - curled up, and when she moves she whimpers. Is this normal after such a major surgery? She is on buprenorphine already for pain.

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  17. Please someone!

    My cat just had surgery to repair her three torn knee ligaments. She got home this afternoon and has been laying down, whimpering when she changes positions and just generally looking like she is in so much pain. Is this expected so soon after a major surgery like this (she was under anesthesia for almost 2 hours because of the complexity of her case)? It is killing me to see her like this - she is my baby. I will call the vet if she does not improve tomorrow. Just looking for some advice or encouragement.

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    1. HI Jillian,

      there is expected to be a source of pain BUT there is also expected to be an adequate pain management in place. If you cat is in pain, you need to get back to your vet/surgeon and have the pain management plan revised.

      You cat should not be in pain! There should be adequate medication to prevent that.

      Do call them right away, they need to adjust the meds.

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    2. I was so exhausted I don't even remember posting here twice, and sounding so frazzled.

      Update: the next morning she was no longer vocalizing or shaking. She took it easy for a couple of days and now she is wanting to walk and play and run. It is SO hard to keep her still (she is a cat, after all). She twists and kicks when it's time for medicine - I hope that can't compromise the surgery. She had Tightrope, which is way stronger than normal extracapsular, so that makes me feel a little bit better. I stay with her all day, watching Cat-TV shows on Youtube or playing with her favorite toy - that twisty thing that comes off of a gallon of water when you first open it. I will be on edge until she is back to 100%.

      She toe-touched the next day, and is now walking with a limp - sometimes the limp is very noticeable, other times very mild. She is weaning off Buprenex because it made her quite constipated.

      How did you all handle the emotional stress? I am just a wreck, paranoid about whether every move she makes will cause the surgery to fail. Did you have any "close calls"?

      I'm glad there is a site like this, even if it is not about cats - there is pretty much nothing on cats' CCL injuries.

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    3. Hi Jillian,

      glad she improved. Yes, it is very stressful, but one kind of gets used to it with time and improvement.

      Some limping this soon after surgery is to be expected; there was a lot of tissue trauma which needs to heal. You vet should have given you a rehab and progress schedule ...? That way you'd know what to expect and also what to do.

      As for moves, the most dangerous are the ones with high impact or twists. With dogs, it is recommended they don't jump off and on anything and don't use stairs. Not sure how this can be applied to cats - is she being crated? Just kicking legs in the air shouldn't be a major risk I wouldn't think, as there is no impact involved.

      Do what you can and hope for the best. Think of what's the worst that can happen - that the surgery would need to be done all over - which wouldn't really be the end of the world.

      Best of luck and speedy recovery

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    4. The vet's only instructions were to keep her in a room with no furniture to jump on, for a month. He said that the procedure stabilized her knee immediately. I've done relentless hours of Google-ing though, and there isn't much information on cats. A few veterinary sites do suggest that a cat's lighter weight necessitates less restriction.

      I wish I had time to research and compare a bunch of vets, but her knee was so badly damaged (three ligaments gone, putting 4th at risk) time was crucial. He is a published researcher, former professor at OSU, works with VCA and with all the local vets, seems very respected - so I was surprised when there was such little instruction after her surgery.

      My cat is my entire world, though, so I am going to learn all I can about recovery, and I am asking about laser therapy tomorrow.

      Thank you for your quick responses. Your blog is amazingly informative!

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  18. Well, I don't know anything about cats either, just about dogs and about knee surgeries. I fully agree with the not jumping. It could be true that since cats are generally lighter, one month of restriction is enough.

    For more specifically cat information, you need to find a cat blog :-) This is a dog blog. You could try www. pawbly.com

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