Tuesday, August 2, 2016

Cookie's PRP Treatment for Partial Cruciate (CCL/ACL) Tear Update and Considering the Future

Cookie has been doing really well.

Her physical therapist is thrilled with how far she's come. Cookies muscles are getting bigger and
stronger, remaining flexible and relaxed. You can see the muscles rippling on her legs again.

Technically, she's been cleared for normal activity.

I've been increasing the amount of running and walking in challenging terrain we've been doing together. We could start letting her of the leash.

This has been a source of a dilemma for me, and here is why.

Her knees seem to be doing well and should be able to take whatever she might throw at them. And if we're lucky, they will never give her a problem again. But what if we're not lucky? It could well happen that her first chase after a bunny could cause another injury. The chances are always 50/50, right?

This could, of course, happen with perfectly good knees too.

This could happen if there was never anything wrong with them. When we were discussing the PRP option with Jasmine's vet, he brought up an important point, "Say that the treatment works and restores the ligament(s) to their original healthy state. We need to keep in mind that what caused the cruciate(s) damage the first time might do that again."

Aware of that we are supporting the ligament health the best we can with nutrition, supplements, acupuncture ... But it could still happen.

Normally, that's a kind of risk one needs to live with having a dog.

It's a risk we've been taking the whole time. But ...

We don't like the TPLO. We really don't like the TPLO. The traditional suture repair worked for Jasmine but with Cookie the risk of failure during post-op is higher. Cookie is VERY enthusiastic.

Now we know there is an option out there which we do like - the hinge technique, Simitri Stable in Stride. We feel that if we had to do a surgery on Cookie's knee(s), that's the one we'd choose.

Here is the catch.

Cookie is too large for their present implants size range. They have done large dogs with the existing implant but the failure rate was higher. They are working on developing a larger, stronger implant, for larger dogs.

Initially it looked like it should be ready by summer but now the timeline has been pushed to the end of the year.

The option we like is out there but not available for Cookie at this time.

Should she bust her knee now, we would have several options. We could do nothing. That is not a good idea at all, though. We could do the TPLO. But we would really rather not to. We could see whether Dr. Neil would implant the available, smaller hinge for her. But that increases the risk it might not hold up.

Or, we can try keeping Cookie's knees safe until the larger implant is ready.

After a lot of discussion and deliberation that's what we decided to do. Cookie is happy enough with her walks and outings the way they are, on leash. I try really hard to make sure she can go where she wants and do what she wants within reasonable limits.

If Cookie was miserable about this, we'd look at things differently. But since this is working well enough, we feel that this is the best decision for her.

Her knees might never give her trouble ever again. But if they do, and if we manage to safely bridge the time until the new surgery could be done for her, we believe that would be the best scenario.

The other thing is that it's too hot, at least for now to let her run free anyway.

Last summer we kept her on leash during the heat because if she was tracking a bunny she would not stop. Not until her body collapsed under her.

What do you think? What would you do?

Related articles:
From The End Of A Lead Line To Casa Jasmine: Meet Cookie, Our New Adoptee
And So It Begins Again(?) Our First Health-Related Heart Attack With Cookie 
I Didn't Know I Could Fly: Why Cookie Wears A Harness Instead Of A Collar
C.E.T. Oral Hygiene Chews For Dogs CAN Be A Choking Hazzard 
Our First Health-Related Heart Attack With Cookie: The Knee Or The Foot? 
Creative Solutions And An Incidental Product Review
Too Young For Pot: Cookie's Snack With A Side Of Hydrogen Peroxide  
Taming Of The Wild Beast: Cookie's Transition To Civilization  
Staying On Top Of The Ears: Cookie Is Not Impressed  
Putting The Easy Back Into Walking
Cookie's Ears Are Still Not Happy 
The Threat Of The Bulge Is Always Lurking 
Today Is Cookie's Three-Months Adoptoversary  
Cookie Meets The Electric Horse Fence And Her First Chiropractic Adjustment  
Why Examine Your Dog's Vomit? 
Why Is That Leg Still Not Happy? Cookie's Leg Keeps Getting Sore 
Cookie Too Is Insured With Trupanion
Does Being Insured Mean Being Covered? Our First Claim With Trupanion
Is Cookie's Leg Finally Getting Better?
Is Cookie Going To Be Another Medical Challenge Or Are We Looking To Closely? 
The Project That Is Cookie: Pancreatitis Up Close And Personal  
Pancreatitis: Cookie’s Blood Work   
Another Belly Upset: Pancreatitis Again Or Not?  
Happy Birthday, Cookie 
Incontinence? Cookie's Mysterious Leaks 
Who's Training Whom? Stick And Treat 
Don't Just Stand There, Do Something? Cookie's Mysterious Bumps 
Cookie's Mysterious Bumps Update
One Vomit, No Vomit 
Happy One-Year Adoptoversary, Cookie!
Cookie's Leaks Are Back: Garden Variety Incontinence Or Not?
Cookie's Leaks Update 
Don't Panic, Don't Panic: Know What Your Job Is 
The Continuing Saga Of Cookie's Leeks: Trying Chiropractic Approach 
Cookie's Minor Eye Irritation
Regular Wellness Exam: Cookie's ALT Was Elevated 
Cookie's Plantar Paw Pad Injury 
How Far To Take It When The Dog Isn't Sick?
Cookie Has Tapeworm Infection 
Cookie's Elevated ALT: The Ultrasound and Cytology  
Cookie's ALT Update
The Importance of Observation: Cookie's Chiropractic Adjustment
Sometimes You Don't Even Know What You're Looking at: Cookie's Scary "We Have No Idea What that Was" 
Living with an Incontinent Dog 
Summer Dangers: Cookie Gets Stung by a Bald-faced Hornet 
To Breathe or Not To Breathe: Cookie's Hind Legs Transiently Fail to Work (Again)
Figuring out What Might Be Going on with Cookie's Legs: The Process 
Figuring out What Might Be Going on with Cookie's Legs: The Diagnosis 
Cookie's Iliopsoas Injury Treatment: Trazodone  
Cookie's Iliopsoas Injury Treatment: Other Medications 
Cookie's Iliopsoas Injury Treatment: Laser, Hydrotherapy and Chiropractic 
Cookie's Recovery from Iliopsoas Injury: ToeGrips 
It Never Rains ... Cookie's New Injury 
Mixed Emotions: When What You Should Do Might Not Be What You Should Do for Your Dog 
Cookie's New Injury Update 
Cookie's Iliopsoas Injury: The Symptoms 
Cookie's Iliopsoas Injury: Battling the Zoomies 
Cookie's Muscle Injuries: What Else Is Going On?
Theory and Actual Decisions for an Actual Dog Aren't the Same Thing: Cookie's Knee Injury
Does Your Vet Listen to You? Cookie's Post-Sedation Complications
Would I Ever Treat a Symptom Directly? 
Platelet-Rich Plasma (PRP) Treatment for Cookie's Bad Knee(s)
Platelet-Rich Plasma (PRP) for Cookie's Bad Cruciate Update 
Injury or Surgery Recovery: Mishaps versus Setbacks 
See Something, Do Something: Cookie's Lumpectomy 
Cookie's Lumpectomy Update 
Using Pressure Pads to Evaluate Lameness in Dogs: My Observations
Cookie's Musculoskeletal Challenges: What Supplements Am I Using?
Cookie's Musculoskeletal Challenges: Restricted Activity and Weight Management
Cookie's PRP Treatment for Partial Cruciate Tear: Update
Has Your Dog's Physical Therapist Taken Dog Training Classes? 

Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from yo


  1. I would do the same thing. I'm not a fan of TPLO either and I'm glad to hear others feel the same way. So intrigued by the hinge technique!

    1. Thank you, Jen, it's good to hear somebody else would think the same way.

      Yes, the hinge technique seems like a great idea. It's still hardware in the body but no anatomy alteration ... certainly makes most sense to us at least with the presently available information.