Gus, Great Pyrenees Knee Surgery, Hip Surgery, Complications

Hi Deborah,

Gus Maxwell Porch Swing Sling
Gus Maxwell Porch Swing Sling
Teri also commented on Rehabilitation and Conditioning for Animals’s link on Facebook

Teri wrote: “Hi Deborah Carroll…although you did a superb job working with our Great Pyrenees Gus post-surgery…I would also HIGHLY recommend to anyone considering surgery (especially on a large dog) to go to all lengths trying non-surgical resolutions. As you know, Gus had the knee surgery and had every possible complication including blowing out the opposite side hip joint. Although he doesn’t consider himself disabled….I wish I had done things differently when he first had symptoms. As always….you’re the best!

My note:

The above picture is from my (Deborah’s) files…Gus enjoying the day in his porch sling I made, using pulleys and my favorite cheap harnesses (Travelin’ Dog from Petsmart online-use in rear and sometimes front). Owner Mom could help him outside during the day and then get him upright using the pulleys without as much stress to her body. I think Gus weighs more than she does!

 

 

Changing Pain Relievers for Pepper-Torn Ligament

Changing Pain Relievers for Pepper-Torn Ligament

Deborah-

Dr. L prescribed 2 weeks worth of Gabapentin and wants to have a check up with her on Feb 11th. He said that it is definitely a torn cruciate but will reassess for the meniscus at her check up.

Pepper is willing to put weight on her leg without any ice with the additional pain meds, and almost doesn’t ‘cheat’ at all on her walks! So far she may only miss 3 or 4 steps by cheating now, where before we were lucky to get her to get several good strides in a walk. She’s already even starting to use it a little on her own in the house. K said that he had good results with her walks when he sat and iced her knee for 30 minutes.

Her pill regimen now is 1.5 tramadol 3x/day, and 1 gabapentin 2x/day with the rimadyl at 0.5 2x/day.

I think that is all for now!
Jan 29

to B-

That is great!
So, do the five minute walks this week, getting success at weight-bearing, and then next weekend start her on the ten minute walks.
I think we can make some headway now 🙂
What milligram dose is the Gabapentin? 100 or 300?
Blessings-

D-

Its 100 mg. It’s still amazing to me the difference in her walks!

Jan 29

to B-
Good… That’s even a pretty low dose for her size, It’s just a better drug for her body chemistry, evidently, and it often works really well along with Tramadol.
I am very happy about this!

Hi Deborah,

Pepper is not getting any sleepier than normal with the added pill, but I’m not sure that I have seen much decrease in her limping. I forgot to mention that she has been out of glucosamine for about 1.5 weeks, so that may have a little effect. It finally came in the mail tonight so she will be back on track with that.

She is taking the new walk time well.

B

Hi B-

Overall, great info.

So, you gave one more Gabapentin along with the other pills? Twice a day or just once? Also, the Glucosamine could make a substantial difference. In the near future, maybe we can switch her to a natural anti-inflammaroty, Xyflamend, instead of the nsaid she is taking, after she is pretty stable for a while and not any additional lameness…

Deborah

Deborah-

We are giving her the additional gabapepentin with all the same pain meds.

I would definitely like to get her on a safer antinflammitory. Do you have any experience with bromelein? B

B-

B-

good…

yes, I have experience with it, and let’s talk about transitioning at my next visit. I feel it’s too soon right now because we just got to a better place, so let’s give her the stronger tools to keep getting better muscularly, and then we’ll transition her to biologically kinder interventions for longer term.

good? 🙂

Deborah- 

sounds good! 

Pepper will need refills on everything by the end of next week. I didn’t realize that he changed her dose of the Rimadyl. He changed it to 1/2 tab per day and she was taking two 1/2 tabs per day.

B

Feb 24

B-

Good-

That’s a step in downsizing, and what you need to look for is more lameness with less drugs. I realize you are now giving more Gabapentin…has there been less lameness with that? And then look to see if there is more lameness with less Rimadyl.

She won’t need the same drugs/doses “forever”, but once we get on the upside of the pain, there is no sense in removing the drugs before the rehab work is done, so I do it in increments, looking for more muscle and function production and less lameness.

I’m sure that makes sense 🙂

Blessings-

And, as for switching to a natural anti-inflammatory,

Remember that Omega 3’s are anti-inflammatory (whereas the other Omegas are pro-inflammatory), and you also mentioned that you were going to get more of the Glucosamine/Chondroitin/MSM joint formula Pepper was using before you ran out. Both of those are good to implement now and for the duration of her life, as you probably know.

Like I said in the email I just wrote, the vet reducing the amount of the nsaid is a step in downsizing, and what you need to look for is more lameness with less drugs. I realize you are now giving more Gabapentin, too, than you previously were…has there been less lameness with that? And then look to see if there is more lameness with less Rimadyl. In the older dogs with torn ligament and torn meniscus, we have consistently gotten better pain relief with an nsaid, Tramadol, and Gabapentin all together in moderate doses. This always seems to work better than trying to eradicate pain with high levels of just one or even two drugs. She won’t need the same drugs/doses “forever”, but once we get on the upside of the pain, there is no sense in removing the drugs before the rehab work is done, so I do it in increments, looking for more muscle and function production and less lameness.

I often remind people that once we get to the good pain relief with the least lameness we are thoughtfully able to accomplish, then we need to stay there while the functional drills progress (so long as blood work supports that). Often then along the way less lameness is realized, less pain, because the muscles build and the joint settles down and other positive things are taking place. It is only after good, consistent success with exercises and drills that we want to play with reducing the pharmaceutical medications. Often, then, if there are no conflicts, I encourage some of the older dogs to get on Xyflamend, which I have found beneficial and have been using more and more recently in conjunction with a local vet who is well-versed in herbs and knows there are no conflicts. I have personally used the product for a couple of years now as part of an anti-inflammatory regimen for my body as well as for some joint and muscle pains.

You asked about bromelain as a natural anti-inflammatory, and I’m aware that the internet is full of testimony toward Wobenzym N, a popular supplement that contains bromelain and other protease enzymes and that it has been around for quite a while. I tried it for a bit in the 1990’s. The approach is different in Wobenzym N than Xyflamend, and maybe both would eventually be good for her, but they are also not cheap (neither one), so I usually start now with Xyflamend due to the advance of research into some of its components and because I really, really like tumeric/curcumin 🙂

My finding is that (unfortunately?) there is not any one natural remedy that has the impact on greater pain, like Pepper has and like most of my patients have, that pharmaceuticals have, and I have found that a combination of natural substances, like Xyflamend and/or Wobenzym N and Omega 3’s and Glucosamine/Chondroitin/MSM at the forefront, works best for long-term maintenance.

There definitely isn’t one natural compilation along with interventions from us, like massage/ice/heat/laser, that will take over in a situation like this, with torn meniscus and with her ongoing pain that we’ve had a difficult time finding the right combo of pharmaceuticals to address. I have found this out over time and through very many cases, even in thinking of allowing for every being having slightly differing biochemistry. In time, though, and with thoughtful progress, we should be able to transition to more natural aids without also putting a huge dent in your schedule for the day!

I had a client at one time with a quite elderly mid-sized dog, and he did not want to use any pharmaceutical interventions. This dog appeared quite painful and was very, very stiff from arthritis. I had him doing a regimen of massage and ice and I did laser therapy. He also used several neutraceuticals (Omega 3’s, joint formulas), and I also recommended Epsom salt baths (rinsing very well after). These interventions, along with some others, did little to quell the pain, yet the time investment was around 3 hours daily. I finally talked him into dosing the trial of Rimadyl the vet had given him, and his pet was notably substantially better by later the first day. Unfortunately for the dog, I don’t think he continued with that medication and he fell off of pursuing rehab interventions.

I won’t take time here to get into windup pain or concepts of getting on top, over the top, of substantial pain and minimizing the reactivity. I think we are on a good path with Pepper so long as she continues to show improvement. Keep me posted!

Blessings-Deborah

9 1/2 yo Lab Mix Torn ACL/CCL no Surgery

Cathy
(originally submitted under comment section of “Anecdotal Progress” post)
Submitted on 2012/12/17 at 8:15 pm
I agree that exercise can help heal. My 9 1/2 yr old lab mix tore her ACL in September and we chose not to have surgery for many reasons. I found your site and we began the SLOW short walks 3 weeks after the injury. Other than that she was restricted to my bedroom and potty breaks outside. We began with 5 minute walks twice a day. It has been over 3 months now and we have progressively increased the duration of her walks. Today she walks about 20 minutes at a reserved pace twice a day. Her limp is barely noticeable. In the house we only restrict her (with a baby gate) to my carpeted bedroom when no one is home to prevent her from chasing the cat or freaking out at the doorbell, etc. and we bought cheap runners to put on the hardwoods to create no-slip paths for her. She takes Glucosamin/Chondroitin and Green Lipped Mussel supplements daily, and we cut her food back somewhat so she stays “skinny”—-no extra weight on the knee. She is on a no grain dry food mixed with canned. She was on Rimadyl for a month after the injury and Tramadol for 2 months. I took her off both now. I know she may never go back to unrestricted running and chasing the insane Papillion dog next door—- but she is getting better without surgery or drugs for now.
Here is my question: How can I find a vet who is supportive? My vet sent me to a surgeon and they weren’t positive about options or alternatives. I would also like to know if you recommend water therapy?

rehabdeb
Submitted on 2012/12/19 at 9:05 am | In reply to Cathy.
Hi, Cathy!

Thank you so much for your feedback, and commendations to you for being fastidious with the program 🙂
According to what I saw in my email feed from your post, you may be in North Carolina? I do know vets, specialists, and rehab practitioners in N.C., specifically Raleigh, however I will say you will likely, at this point, gain more support from a horse trainer and the horse racing community.
When I came into animal rehab at the end of 2004, I came from a varied and dynamic background in human sport science, to put it succinctly. I came to animal rehab expecting to find program protocol, functional program design based on dynamic neuro-muscular principles, and info of that nature. There wasn’t any I could find published on the web. I found some wonderful articles by Dr. Jan Steiss, Auburn, one of the first vocal practitioners of DVM-based animal rehab, but nothing along the lines of the very intense sport science journals I’d been reading and the coaching practices I knew. In the following months and years I began writing easy, land- and home-based programs, so that patients I was seeing even in a hospital clinic setting could benefit from applied and thoughtful homework. I now realize I have a lot more broad background in body wellness and functional program design than many people in veterinary medicine and veterinary rehab, and while it’s awesome to see info I take from centuries, really, of practice that began in human sport science and repair (long before I came on the scene…:)), being so very simply beneficial to the animals I work with, it’s complicated to gain an ear at times. Keep in mind that no professional can know everything, and since in a broad view, so many disciplines are and can be linked, it just takes time for mass acceptance. I have no staff, and until I take time to write and publish more of my anecdotal findings more formally, there will be nothing for others to note or contest. I hope that makes sense. It’s been like swimming up a waterfall, because I’ve been aware of a lot of the principles I use for muscle strengthening, bone strengthening, recovery from injury, etc…since the late 1970′s. I have seen that even if papers are published, the majority will remain hesitant, and that seems to be the way it is with so many things. I think that most often we/they/anyone has to have a dynamic personal experience to hop our thought and process over the ridge of the rut to begin traversing a different path. I can remember some of my light-bulb moments over time and my astonishment that what I now “knew” wasn’t broadly taught or widely accepted…several times this has happened over the past 30 years or so, in a variety of venues.
So, I don’t recommend water therapy for your case, based on what you have said in your note. I don’t see overall beneficial reason for it in over 95% of my cases. This is because a thoughtful, progressive, controlled, land-based, gravity-based, exercise protocol will do more to provide return to overall function, repair of hard and soft tissue, and be less expensive for the people while less disruptive to the animals. And the land-based protocol only work well in the environment of appropriate, lameness-duration-based pain management. I have come to the conclusion that so many animals are over-worked in the water treadmill without appropriate pain control and they are returning to function, slowly, painfully, and it’s not a miracle or even an awesome tool, in these cases. What is an awesome tool is appropriate pharmaceutical pain management coupled with the controlled, super slow, walking and then beyond-the-basics, return-to-function program.
The quick answer as to why/what works about the programs I’ve written is that it is slow and therefore not further concussive on the joint. Slow also means more equality in weight-bearing on all limbs…no cheating, which happens when they go faster. Slow means it will be more painful because we are asking for the injured or surgery limb to be used, but if we control it (use a harness, too!!), then we are not inducing damage…we are just asking for use. Pain meds take away the painful part and we get better use. Better use means muscle and supportive tissue builds. Surrounding soft tissue and supportive structures will, in turn, support the joint. Over time, many of my patients have rehabbed torn CCL knees without surgery to the point that their vets could no longer get drawer motion nor could they really differentiate between knees. None of the properly rehabbed ones have gone on to tear the opposite knee ligament. This is huge.
Lack of adequate pain control is a thorn in my practice, and I’m trusted by the vets in this area who use me frequently, so they understand when I send an animal back for review of meds. I cover pain issues in a Q&A post I think I entitled “Should my Dog Still be Limping…”. There are three main reasons I see pain and lameness, so check out that note, too, if you’d like.
I also think I have posted a note elsewhere on this site regarding water treadmill, and I go into more depth about it therein.
I’ve got to run to appointments.
I hope this is helpful, and I really appreciate your taking time to write!!
Blessings-
Deborah

rehabdeb
Submitted on 2012/12/19 at 9:10 am

…also, if you’re on Facebook, check out my FB rehab page:

https//www.facebook.com/animalrehabconditioning

and it sounds like you could use a phone consult from me, if you’d like. You could use a little more direction for the next steps, and I have dogs returning to agility competition, hunting, etc…without surgery, so more can usually be achieved than where you might be now.
ciao-

When the Owner is Unable to Care for Their Pet…

I just received this question in my mail, again (but from someone new), and I thought I’d take a moment to post my answer here on this blog. I know that I have been asked if I minded if I were named in a will as caretaker to some former patients, should the owners pass on before the beloved pets do. I also know that although my Great Dane, the Grace, had an exuberant yet complicated physical status, several people would have been in line to care for her, and I had already cleared with the #1 choice that it WOULD happen. If something had happened as well to #1, I’m pretty sure that #’s 2 & 3 would have figured out things, and some different peeps were interested in the Grace’s cat, Calvin.

That being said, here is the Q & A, mostly for the purpose of getting you thinking about this situation for yourselves…

Hi Deborah,
How are you? I’m wondering if you know of any options for longer term care/fostering of dogs? Versus boarding. My mom has Parkinson’s and fell and dislocated and broke her shoulder. We expect she is going to be in some sort of rehab care facility for the next 3-6 weeks. We will ask our vet too but thought you might have some insight. Thanks!

(Now, I will add that I am also 4.5 yrs out from a breast cancer diagnosis, and I am very active in the local cancer community as well. This note comes from a cancer sister who has moved out of the area and is really seeking help. Many of the people who contact me have not given this type of situation much thought, however many others have a multiplicity of issues, dynamic lives, and the answers may not be as cut and dry as one might assume…)

My answer:

I don’t think I have any really “great” ideas, however here I usually tell people to contact a rescue group associated with the breed they are trying to get cared for, if there is a specific breed. Otherwise, there are a couple of good rescues that may have a better answer, like XXX, XXX, & XXX.
It’s a good question, and I think that over time, somehow, it’s an issue that needs to be better addressed…maybe…I actually get a mail about this at least once per month, it seems. Someone will be sick or will have died and the animal needs care…I guess that once an animal has a home, it is assumed that the owner has friends or family to take care of the pet. I know that people would have fought over taking care of Grace. Perhaps the bigger issue is that people need to be made aware that they probably need to find “godparents” for their pets, much like we would do with children should we die.
yup.
That seems to be the best answer…otherwise, letting them go is like giving a kid to CPS (no offense to the gals I know working in the system :)) (and that is essentially where my answer ended)

Most people probably wouldn’t want their child to be a true orphan, and I just don’t think we have been challenged to think much the same about our pets.  Most of the rescues and shelters are chock full…unwanted pets, pets from homes of people under duress, lack of spay & neuter (back to unwanted litters), etc, etc…Boarding costs money, and if the owner can afford it, boarding at a play-care facility might be a good option, if the owner is expected to be able to return to the care of their pet.

But, that part of the equation is often an unknown.

Hospice care is up and coming, and relative to that would be orphan or interim pet care…but this needs donations from a tapped community and/or owner-pay to sustain the care. A will would/could take care of the sustained care, however the majority of people I hear from are speaking about interim care of indeterminate time value. Ideally, shelters and rescues in a community that experienced almost no unwanted pet births and had a high rate of owner compliance with spay and neuter could then be more free to care for the animals that are surrendered for reasons pertaining to housing issues or owner health or other unexpected life complications.

Just some thoughts…

 

 

Torn CCL/ACL on 10 yr. Old Lab, Been Torn a Year…

Torn CCL/ACL on 10 yr. Old Lab, Been Torn a Year…

Hi Deborah – I’m so glad I found your blog/website after researching for hours. I am at a total loss of what to do for my beloved yellow lab, Sam. Sam is 10 years old, weighs 98 pounds (vet said he had a large girth) and that his weight was fine. A year ago this vet said he had a pulled or torn ligament in his left leg. She said he could have surgery even though he was old, or prescribe adequan (very expensive) or keep him inactive. There was no guarantee of either treatment. I kept Sam inactive for quite a few months, with limited leash walks. I thought he was getting better but he’s not. There have been a few times; he took off running across our yard, which I know was bad. But I’m more careful now about opening the door and him on the leash. I took Sam for a 2nd opinion yesterday (1 year later), this vet said he had a torn cruciate ligament and needed surgery. He gave no medication for pain or recommendation of using anti-inflammatories. Neither vet recommended Xrays or other tests. They just did the manually testing of his leg. He is slow to get up, limps for a minute but then walks on that leg, but does not put full pressure on it. He doesn’t limp when he’s walking. It’s mostly after he’s been lying down, he struggles to get up, limps for a minute or two, then he seems fine. I limit his walking to about 5 minutes 4 times a day. He never seems like he’s in pain. He’s always wagging his tail even when he’s lying down. The only thing I’ve really noticed is at night while we are watching TV, he normally sleeps; now he seems to stay awake and look around, which maybe that means he’s in pain, I just don’t know. I really don’t want to do surgery on Sam, not at his age. I’ve read quite a bit on your site, and it looks like there may be a nonsurgical route for ACL injuries…. I thought you might allow me to ask you a few questions: Deborah, I live in Foley Alabama, is there anybody like you my area that you know of? Anybody you can recommend? Can you give me any kind of advice of what I should be doing for Sam? Should I let the Vet give Sam Adequan? I will do it if you think it will help. When is surgery really necessary and should it be done on a 10 year old lab? I don’t know who else to turn to, please help. Thanks Lisa from Alabama

Here is the first answer I sent you via Facebook-

Hi-
Here is my FB rehab page, and you may already be a fan, since we have at least one friend in common, but there is no easy way for me to search and sort who follows this page
I will get to answer your post on my website as soon as I can. Otherwise, I do know the answers to all of your questions are on one or both of my sites…it just takes a lot of reading ! So while you wait for me to be able to answer, check out the homework and other related posts if you haven’t already.
Sam does need pain meds of some sort and he does not need to rush into surgery based on what you have told me. X rays won’t show torn ligaments, however they will show clouding in the joint which just tells us what we already know, that there is joint disruption and damage.
See the post I just made on the wordpress blog regarding Clark, the hip dog.
Blessings-

And here are more answers now that I have some time:

I will always do a paid phone consult, so if you are interested, let me know and we will set that up.

I do not know of anyone else that practices the way I do, with standard therapy interventions and certification within veterinary medicine (CCRP) yet using the tried and true, long-standing principles of athletic training and strength training protocol. There are a few people in the U.S. that I know of who also carry the strength and conditioning certification that I do, the CSCS®.

The protocol for dealing with this situation did not exist that I could find when I first came into companion animal practice, in 2004-05. I began writing simple programs based on my background and experience. These have been refined and honed and proved to be beneficial.

Additionally I was blessed with a Great Dane companion for 10.5 years who was bone-on-bone in both knees, had all three ligaments torn in the right knee and two torn in the left. She had a genetic bone disorder called OCD (for short), and had two TPLO’s that didn’t work out, or, the end result was not what we would have aimed to accomplish. I am not anti-surgery and not because of her situation. It is through her situation that I learned even more about improving function non-surgically or in the face of very complicated circumstances.

At the least, I have substantiated with some vets in this area and around about (who have inquired and followed my simple homework) the beneficial effect of slow, weight-bearing, pain-controlled return to function after surgery. I built my Grace’s thigh muscles to better support her joints, and I had plenty of opportunity to see the benefits of increased muscle mass in her case. I have also appreciated the benefits in other cases.

I hope that you have found many of the other answers you were seeking elsewhere in this blog.  I suggest pretending like it all just happened and start at the beginning of my homework suggestions (under “homework”) and I strongly suggest, as I said previously, that you obtain an anti-inflammatory if Sam’s system will support it (your vet will do blood work to substantiate this), and if not an nsaid, then use Tramadol or Gabapentin. There are lots of options for pain control (see my Q&A post regarding limping after surgery), and if you just pretend like it happened recently and really start again at the beginning, building up from there, I really think you will realise great benefit for Sam.

Adequan seems to work really well on relatively few dogs (animals). I tried it a lot in my Grace, and I was working with a surgeon friend, so we tried it three different ways (IM, IA, SQ)on three different trials, to no effect for her. Some of my clients say it has helped their dogs substantially. A surgeon on the East Coast told me in 2005 that he didn’t think it would work for my Grace and that they had stopped using it in horses due to little effect. It’s expensive, yes, and it’s great if it works on your dog.

In the meantime use fish oil and a glucosamine/chondroitin/msm combo for joint health. Your vet may carry these products. I have info posted elsewhere regarding these supplements. If Sam takes off running and injures the joint, then make him rest for the remainder of the day and he has to go back to slow leash walks until he is no longer lame. You may also use ice, right on his knee, 20 min, when he has a limping/lameness episode. Hopefully you will be able to have a veterinary relationship where more pain medicines are utilised for greater overall benefit. Check out www.ivapm.org for more pain management info. I’m with you in that he is probably uncomfortable at night. Pain meds will help this, and the other options I gave you will help it some.

If he were my dog, I would definitely follow my homework and the supplement advice, the pain med advice, and I’d recheck with me when the first four weeks of homework are completed. I would not have surgery on him right now based on what you have told me, however I also have seen older dogs do well in surgery…so it’s not the surgery that is offputting; it’s just that I think he can thrive, based on what you have told me, without surgery. You have opportunity to find out if you get strict with the restrictions and homework again. He will have difficulty every time he spazzes out until he builds more thigh muscle. Then the joint should suffer less impact. At the least, if you follow this simple homework, it could serve as pre-hab, and if you decide on surgery, he will be in better shape and presumably recover better after surgery.

That is all I have time for right now.

Our next consult should be a paid phone consult if you’d like to go further. Thanks for presenting Sam to us-

Blessings-

Deborah