physical therapies in the treatment of dogs

PetMD has a great article today on physical therapy for pets.

When Penny damaged her cruciate ligament, I searched for reliable information about what to do, and I would have loved to have read this article.

Eventually we settled on a traditional repair of her cruciate ligament damage, and were happy with the surgery, but the vets did not emphasise the necessity for follow-up therapy. However, from research on the Net we decided it would be helpful.

I'm glad we did, because I don't believe Penny would have recovered as well as she did, without the underwater treadmill, swimming and canine physiotherapy. We followed it up with a long period of home therapy, using exercises given to us by the canine physiotherapist, from Dogs in Motion. (And I'm excited to see that Dogs in Motion now has a blog!)

Dr. James St. Clair's home therapy booklet was a godsend also, and it became our bible for more than a year.

Penny still swims regularly, but looking back through my blog to compose this post has alerted me to the fact that perhaps we should also be doing ongoing home therapy. I'm going over right now to check out the Dogs in Motion blog.

increasing a dog's vocabulary

After watching more of the BBC television programme, 'The Secret Life of Dogs', I was amazed by the canine genius who has a vocabulary of more than three hundred words. Betsy can bring on command a huge array of named objects. And, if you watch the video clip, you will see that she can even conceptualise from a scale model of an object to the thing itself, and even from a photograph, which I wouldn't have believed if I hadn't seen it on the BBC.

Now, Penny isn't a genius, that's for sure. But, until she had surgery on her cruciate ligament and we stopped most of her activities, she was using her brain for tricks, doggie dancing and training, every week, if not every day.

When we were told she needed to take care with the leg, we began to restrict her activities. We eventually resumed walking, and now swimming, but we forgot about the intellectual stimulation she needs.

So, it's back to training for Penny. Here's a video of our usual amateurish style of 'kitchen training'. We're challenging ourselves to increase Penny's vocabulary and I reckon by the time she's 110 (human) years old, she should know as many words as Betsy.

dogs and life's simple pleasures

Penny went down the back steps today and into the backyard to rest in the sunshine.

How wonderful such simple pleasures are! Six months ago I wouldn't have thought anything of it, but after four months of her recovery from cruciate ligament surgery, going everywhere with her on lead, it's so great so allow her to come and go as she pleases.

twelve weeks after surgery!

Hooray! We've made it to the twelve-week mark after Penny's surgery. The surgeon said after this period we could 'start to return Penny to her usual activities' - whatever that means!

However, the physiotherapist says sixteen weeks is a safer length of time, so I'll go by her recommendation. When I look at this video of Penny walking in the underwater treadmill, I can see that she is still favoring her left rear leg.



So I guess it'll be a few more weeks of the treadmill and of staying on lead whevever she is out of the house. (However, I did let her walk beside me off-lead down a local lane today, because it is quiet and straight and not too interesting. It was so-o wonderful to have her walking free beside me.)

The vet nurse who supervises the treadmill says that the water takes seventy percent of the dog's weight, so the treadmill gives her a chance to walk steadily for fifteen minutes, and of course the warm water not only provides resistance and muscle-building capactiy, but it's also comforting for a sore or aching leg.

weaving as therapy for Penny after her cruciate operation

Who'd have thought, six months ago, that we'd be thrilled with a thirty-five minute slow walk to the park, with Penny on lead? It just goes to show it's all relative. After ten weeks' rehabilitation from her traditional extracapsular cruciate operation, walking has become the highlight of our day.

I thought we'd add something extra yesterday, so we did some weaving between the poles along the edge of the park, with the idea that as she changed direction she'd be shifting her weight from side to side.



We might have done more, except that the heavens opened and we got half-drowned in the deluge. (Still welcome, though. We know southern Australia is still in drought, even if it's raining at the moment.)

steady progress by Penny

Penny today passes the ten-week mark since the extracapsular surgery on her cruciate ligament! Now she is allowed to walk daily for thirty minutes!

However, we still need to go at a slow pace. The physiotherapist says she can move to a trot next week, as long as she is putting her weight on all four legs and doesn't show any lameness.

Another big step (here comes a pun!) is that she is now allowed to go up and down a couple of steps. We'll leave our handy ramp in place, but I've cut back the foliage from the two steps that had become overgrown in the last four months and this evening we used the steps.



Our physio has suggested that we never again throw balls for Penny to chase, never let her jump into the car and never let her jump onto furniture. A few months ago I would have been very sad to think of these limitations, but over the last weeks I've seen that Penny can be happy without all the activities we used to do, so I think we can live with these restrictions.

going for very slow walks after surgery

I was looking at this video clip I took last week of Penny setting off for a short walk with one of her humans and I was interested to see how clearly it shows the need to go at a slow pace after extracapsular surgery for her torn cruciate ligament.

When Penny came off the ramp, she hopped instead of using her left leg, and when her human picked up the pace a little at the end of the driveway, Penny once again hurried along without exercising the leg that has lost muscle tone.

We've been told that walking is a way to build up stamina and strength, but that it still needs to be very slow at this stage.

the Great Saga of the Poo

Okay... imagine this. You're in the car park of the Animal Emergency Clinic, about fifteen kilometres from home and it's four in the morning. Your dog, after shivering and panting in pain on the rush across town in the middle of the night, is now running full pelt around the car park, you hanging onto the leash and running behind her, so your tugging doesn't pull her off balance.

Yep, it's day four after the cruciate ligament surgery.

You check on Penny in the night and find her in lots of pain. Ring the University Clinic where she had her surgery (many, many kilometres from home). Tell them her symptoms. Maybe you should go to the nearest emergency clinic, the voice on the phone suggests. You decide to go to the one you have the most respect for. You drive there, resisting the temptation to run the red lights (and resisting the voice of your companion urging you to do just that).

You arrive there, carry her in, put her on the ground, oh so delicately, and she hurries across the room, wagging her tail, to greet the nurse. What??? She seems okay. But then she's not so good. She hurtles across to the door and you go out with her and she races all over the place, hopping along at top speed on three legs, crouches and out comes a flood of urine. Whew! The trip was worth it even to achieve this.

Inside to tell the nurse she seems a lot better. Then she's off again, hurtling along the footpath and onto the grass of the nature strip.

And then, it finally happens. The Great Poo. Twice. Oh, the relief she must feel at getting something moving after five days! We can relax now, having read that it's only after five days that we should start to worry if there is no bowel movement.

The vet nurse tells us we can stay in the waiting room for fifteen minutes to see if Penny's fine. The staff have emergency cases in the hospital that take priority over Penny.

We wait until another nurse comes out to greet a new client who's vomiting blood. We thank the nurse and head off home.

Tired but happy.

a Robert Jones bandage and repair of a partially torn cruciate

Penny has a rather pretty bandage on her leg after the operation to repair her partially torn cruciate ligament. Searching the net today for information, I've discovered an article at PetPlace describing it as a Robert Jones bandage.

The surgeon told us to be very careful that it doesn't get wet, so we've been crawling around the backyard feeling the ground for dampness - ah, what we do for our beloved dogs! But now I've read on the PetPlace site that we should have a plastic bag right over her bandage when we go outside, because she might accidentally wee on it and make it wet.

We took turns to get up at two-hourly intervals during the night to check on her - yawn - and she slept well. She can apparently shift around, because we see her in different resting positions when we check on her during the day.



I read a report on the history and use of this bandage and was pleased to read

By supporting the soft tissues, the Robert Jones dressing relieves pain and may facilitate healing.

And, at another site, I read

It promotes healing by immobilizing the injured area, thereby limiting swelling and providing protection from secondary trauma. Compared with other padded bandages, the Robert-Jones bandage offers limb stability, tissue fluid absorption, and protection from trauma. Generally, most of the compression is lost after several hours to days as the cotton loosens.

One of the best finds of all has been a blog by the owner of a dog who has gone through the traditional repair, as we are doing, and also has successfully completed conservative management, avoiding surgery altogether. (We tried conservative management, but Penny got worse.) I'll be reading each week of that blog to get an idea of what we can expect.

Today's big exercise has been carrying Penny out to wee (yes, a good wee in the morning, thank goodness). We know she can wee with the sore leg in the air, because she's been doing it for weeks.

The next step is to see her do a poo. (Oh, how our dogs teach us to focus on the important things in life.) We're not sure how that will go, as it seems to involve putting her weight on both backlegs. The vet nurse told us to support her with a sling under her rear end, but we've been out three times and she just lies down.





Maybe there'll be some action later...

Penny's limp was a partial cruciate tear

At last we have had a definite diagnosis of Penny's lameness - and an operation on the same day!

Here she is, sad and sorry but finally on the way to recovery, after an operation to repair a partial tear in her cruciate.



We've agonised about what to do, for weeks. In one way, I feel sad that Penny has been in discomfort, if not pain, as we researched, discussed, visited a variety of specialists, and finally came to a decision.

However... we were originally booked for Penny to have a TWO, an operation somewhat like a TPLO, involving the cutting of her leg bone. But today the specialist told us that over the last few months there has been research from the US suggesting that the traditional, less invasive cruciate repair gives just as good recovery for dogs of Penny's size. So, while we have been thinking it over, so have the experts.

Here's hoping for a steady but successful recovery.

our dogs teach us to see how special ordinary places can be

Building on yesterday's success in taking Penny to a place where there are no other dogs, I put her in the car today and simply drove off to have a look around. I had the idea of going to a quiet on-lead path near a creek, so I pulled up and lifted her out.

To a human it was a rather ordinary, if not, horrible, place.



Except for the gorgeous street art...



As usual, Penny showed me that every place can be interesting, if you just stop to smell the flowers.



Some spots required quite intense sniffing.





The good thing about it was that she was walking slowly, which the physiotherapist says is important if we are to build up the strength around her possibly injured cruciate ligament. (I always say 'possibly', because my gut still tells me to doubt the diagnosis.)

Penny gets to go places at last

First, I must thank LS and Happy for the award they have given us. It's lovely to get something like that. Seeing I'm not organised enough to keep track of who I've ever passed awards on to, I'm going to just sit on it and enjoy it!

Penny got to go on a walk today!! Ta da!

It suddenly occurred to me that even though she can only go on ten minute on-lead walks, there's nothing to stop us doing it away from home, as long as the terrain is flat. So we went off to the local golf club and wandered around the car park. Yep, the car park. Penny seemed to enjoy sniffing around the garden beds and the ground was firm underfoot and I knew we wouldn't meet other dogs (who might tempt her into playing). We walked sedately down the edge of the course.



I'm feeling much better about trying to manage her possible cruciate tear with a conservative approach, as we've been to see an animal physiotherapist and she, like the vets, thinks Penny's knee is stable, and therefore possibly able to recover without surgery. Even if we do end up with surgery, we'll know we tried all avenues beforehand, and took care of her leg in the meantime.

As well as the supportive and informative Yahoo group about orthopedic issues, we've joined another one dedicated to managing without (or after) surgery, and already I've found a great article that sets out the process by which a partial tear might recover. As I understand it, the ligament can't regrow, as it has a meagre blood supply, but scar tissue can form and with the proper care, tht scar tissue will support the knee, as long as it's not too tight. In other words, we need to keep Penny moving. Seeing that's the way I'm dealing with a disk problem in my back, it seems a logical course at this stage.

I'm looking forward to posting about the underwater treadmill next week. Penny hopped in happily last Wednesday, when the vet nurse threw in some treats and soft toys, so hopefully she will adapt quickly to it when it has water in it.

There's an interesting article at Pittsburgh Dog News that describes an article in the Wall Street Journal about dog knee injuries. Apparently, in the US there are five times more knee operations on dogs than on humans, despite the fact there are five times more humans than dogs. By my calculation, that means dogs are twenty-five times more likely to have such surgery.

It explains that dogs' knees don't lock, as humans knees do, and so the dogs' knees are always bent. However, I have to wonder how wild dogs manage without access to modern surgery, and how dogs have managed over the centuries. I wonder if we have bred this problem into the species.

Penny and the surgery on her cruciate ligament

As I posted previously, we're nervously waiting for Penny to be admitted for surgery on her left knee. I rang today and found some more details about the specific surgery. It's not TPLO, but TWO, which stands for Tibial Wedge Osteotomy. The surgeon will cut a wedge out of her tibia, so that the slope of the top of the tibia is changed in relation to the weight from the bone above.

If we've understood correctly, it will then be unnecessary for her to have a cranial cruciate ligament at all. If her ligament has partially broken, which he thinks is most likely, then they'll either take out the ligament, or just pare off the frayed parts, because this fraying causes inflammation.

We went for a walk today without Penny, and I realised how much I'm looking forward to the simple pleasure of walking with her on lead. Of course, it's our aim to play sports again, do fun agility, and maybe dance together - but just to get out of the house together will be a joy, even if we have to spend months sedately walking on lead.

Penny and cruciate ligament surgery

Well, after consultations with three vets, weeks and weeks of rest, and x-rays, it has been decided; Penny is to have surgery on her left knee. (One thing I've found out over the course of these stressful weeks is that dogs only have knees on their back legs, which seems logical, as we are so closely related and only have two knees.)

We took a video of Penny with us when we went to the specialist vet clinic today - Advanced Vet Care - but didn't need to show it to the vet. I thought I'd post it here as it might be interesting to other people who see their dog has a limp and would like to see the symptoms.

What I see in the video is that when Penny gets up, she slips on the floor, and I think that might be because she is stiff. When she gets up speed - which we've been doing our best to prevent, I might say - she runs with her two back legs together, like 'bunny hops'. She goes about her normal wake-up routine and, just as we do every morning, we get our hopes up and say, "Oh, it's a miracle, she's recovered during the night". But it never lasts...

By evening, after a day spent mooching around, with no walks except toileting outside, she is stiff and sore - and horrifies us by stumbling and falling over as she leaves the kitchen.



The vet surgeon was great, and spent over an hour examining Penny and talking to us, and then he explained the operation. It's a version of the TPLO, which should return her to full mobility, but not for some months.

Veterinary Orthopedic Sports Medicine Group has clear explanations of the operation and the recovery schedule, so we've printed it out and we'll prepare for the long haul.

Our surgeon told us we can expect Penny to return to full use of her leg - well, not completely full, but it should be so good that we won't notice the difference, and she won't be in pain. It should also prevent the onset of arthritis. Here's hoping!

I'll include a few links that I've found helpful in this difficult time:
Woodhaven Labs
Marvista Vet
Joint Pain in Dogs

Pet Surgery Topics
Dog Knee Injury
Practical Tips for Diagnosing and Treating Meniscal Tears - a discussion paper for vets

dogs are funny and unpredictable

Living with a dog demands that we see the funny side of life.

Today Penny had her first off-lead walk in two weeks, after a long rest to see if we could settle her scary limp. I took her up our back lane, where we weren't likely to meet other dogs and where she could walk on flat ground.



When she threw herself onto the ground and began to roll around, I was pleased to think that she was revelling in the freedom from confinement.



But wait? Why did she keep rolling in the same spot? And why was she rubbing the side of her head on the same spot?

Yep. Dog poo.

So home to carefully wash the stink off her. (We don't want to bathe her at the moment, for fear of her jumping around and undoing the good all the resting has done.)

Life consists of short walks at the moment, usually about ten minutes. So, when she set off later in the morning for yet another stroll, it seemed like a good idea to try to film her gait and see whether we amateurs could figure out whether she is favoring her left rear knee. On the video tutorial I referred to in yesterday's post, it didn't seem too hard to film a dog walking.

But Penny wasn't having any of it. Why was her human hiding in the street and filming her? She had to check it out.



We did let her walk - the plan was, quietly and sedately - up two little steps to see how she moved, but as the end of the clip shows, she took it at a fast pace, so we hope we didn't do any harm. I guess tonight or tomorrow we'll know how she's been affected.

It's exciting to see her almost back to her old self, but we do realise that if she has a cruciate ligament injury we'll have to deal with it. At the moment, it's just a matter of taking things slowly and seeing how she goes .

cruciate ligaments and lovely stamps of dogs

Penny's asleep in the lounge room at the moment, hopefully giving her sore leg (and maybe cruciate ligament injury) time to heal. We're at the stage of going for a few ten-minute walks around the streets, now, but she horrified us yesterday by racing up the back steps before we could stop her.

She limped badly last night, for a minute or two, but today seems well, except that on our second walk of the day she suddenly walked on three legs, not putting her rear leg down at all - just for a couple of steps. I think we're going to end up having her sedated so the vet can test the leg properly. He said it's difficult to check the knee when the dog is awake because the muscles are tense. From what I've read - and this site explains it clearly - the test is called the 'drawer' test, and the vet manipulates the knee as if pulling out a drawer in a piece of furniture.

And I've just remembered a fascinating site I discovered ages ago, one that shows a dog's gait during normal walking, hip dysplasia and cruciate ligament injury.

On a more cheerful note, there are some lovely dog pictures coming on our letters, and the writing on these Australian postage stamps says ADOPTED/ADORED. It's a gorgeous set of stamps and should appeal to dog lovers. I like the fact that everyone who sends a letter will get the subliminal message that it's good to adopt.

Penny rests her cruciate ligament

As Penny rests, and hopefully recovers her health, I’ve been learning more about cruciate ligament injuries. Until this scare I hadn’t realised how prevalent they are in the dog world.

I’ve come across a great Yahoo group, where generous people share their experience of canine orthopaedic issues. I posted a question based on our experience and feel encouraged by what I’ve learned so far:

• Some dogs, if their cruciate is not too badly injured, can recover enough to live a good life without needing surgery. One member said her dog was managed conservatively for 8 years before needing surgery, and another member said that dogs who don’t have a significant injury can do well. She had a dog who did well.



• Make a rehab plan, realise it may be months before Penny is completely well, and don't assume she is recovered just because the limp goes away.



• If all goes well, we’ll go to short walks in the street, longer walks in the street, and then eventually some play in the backyard to see how she goes.



• Being overweight is a big problem for dogs (uh oh!), and being only sporadically active can cause injuries.( I think we don’t have to feel bad about that one, because Penny has been active every day since we got her, barring times when she wasn’t well or there was some difficulty getting out for exercise.)



• It's important to make sure she builds up her strength equally on each side, so that she is symmetrical. (Having a disc problem myself has made me aware of this, as for thirty years I have tended to favor one side of my body, and so I know the problems this brings.)

A few sites I've bookmarked are:
Dealing with Cruciate Ligament Injuries in Labrador Retrievers

Veterinary Orthopedic Sports Medicine Group

Mar Vista Animal Medical Center

Miss Sunshade (yet another gorgeous Airedale) has a very interesting and informative site about her stem cell treatment for an injury.

limping dog, worry and anti-inflammatories

Penny's having a quiet, quiet time this week. It all began when her on-and-off limp suddenly was ON! One family member took her to the vet, who thought she might (MIGHT, you notice, so fingers crossed) have torn a cruciate ligament.

Being a champion worrier, I foresaw operations, months of enforced quiet for Penny, etc, etc. So, keen to start getting her well, I gave her the anti-inflammatory tablet that the vet had dispensed. But I hadn't read the written report from Other Family Member properly, and I wasn't supposed to start the tablets that night, because Penny had already had an anti-inflammatory injection that day.

Mild panic. Phone call to the all-night Animal Emergency Hospital, who said, just watch her, it's not necessarily an overdose, but ring your own vet in the morning.

So, sleepless night, popping out every few hours to see how Penny was in her crate. (she usually sleeps in different locations around the house during one night, but we shut her into her comfy crate so we'd definitely know if she vomited or had diarrhoeia.)

How glad we were that she had been trained to be happy in a crate, even if we almost never put her in there.

All fine. And she rested beautifully all morning. I congratulated myself on how well she was resting, not stopping to consider how unusual it was for her to be curled up in her crate all day. I even took this photo to show how she'd voluntarily gone in there to rest.



And then, she vomited. And again. I tried to ring our vet, but he was busy. In all, I rang about six times over the next four hours, trying to catch up with him. She vomited twice more, and went out a couple of times to eat grass.

I'm big into guilt, so I stressed mightily that I had overdosed my dog, but my common sense told me she wasn't vomiting much, so we could afford to wait and see.

Eventually the vet rang me and told me to feed her tiny meals of boiled chicken. We did that and so far so good. (It's evening of the next day now.)

So the vet and I have agreed that she should rest and see how she goes, and I won't feed her any more anti-inflammatories.