Questions About Dog Hip Surgery

 

Questions About Hip Surgery

About Clark

From the client:

You are so awesome!!! We took him to the vet yesterday and he gave me Rimadyl and Tramadol to help with pain and inflammation. I haven’t had him in for x-rays yet, would that be helpful for you? The vet said he didn’t see any signs of being hit by a car recently that would tell him that there was something broken. I was going to have him fixed this weekend, but I can wait if you think it would be best to see you first. You are worth every penny + some and I will be prepared to pay you for the time you spend with him. ;0) He is a shepherd mix about 14 months old. Just a baby with a sweet, sweet heart and a crappy start. Let me know if you want x-rays and if I should wait on having his boys removed and I can be available anytime Wednesday on next week.

Me:

I’ve been thinking about it, and I think it would be a good idea to get the manly-man surgery out of the way first.
When he gets pain meds for that, you may be able to see a difference in his demeanor or comfort, regarding his hips/legs, so take note of that.
Yes, and it may be hard to tell ;))
I can tell a lot without xrays, and often they get in the way in part of our brains regarding a better clinical evaluation. On the other hand, since he will be sedated, it will be a great time for x-rays, so go ahead if your vet is on board (which I’m pretty sure he will be!)
If he gets surgerized this weekend, I could see him next Thurs or Fri or when ever your schedule allows after that…
What do you think?
:)) Blessings-

Me:

After our first evaluation, my bullet point recommendations were to

1) restrict and crate when not at home for the next 2 weeks.

2) Begin exercise protocol noted on my FHO homework sheet, beginning with week 2, 2-4×10 min walks daily, very slowly (wedding march).

3) Use medications as per label, giving the Tramadol 30 minutes to 2 hrs. prior to walking if possible. Regarding your dosing question and the variability noted on the label, give the larger dose in the morning if you will be walking him in the morning, otherwise just give the smaller dose. Give the larger dose when you get home in the afternoon/evening, in prep for 1-2 pm walks. Give 2 hrs. rest period in-between walks (as per homework sheet).

4) Feed grain-free kibble (no barley or oats or rice, either, right now), Omega 3 in fish oil capsules as discussed, and joint formula that contains at least two of the following: glucosamine, chondroitin, msm.

Client:

(after having some problems with Clark, a rescue, and other dogs adjusting)

Hi!

We still have our friend. We made some adjustments and he seems to have settled a little bit. He has the sunroom to himself at night and during the day…we call it his puppy apartment. ;0) Everyone seems happy.
We took him off the Rymadal (SP?) because he was getting sick. And I’ve scaled back on the pain meds and give them when he is looking a little stiff. We are trying REALLY hard to stick to the directions, but I’m afraid it’s a modified version. He is still during the day and at night and we have shortened his time outside with the girls and I’ve been good at at least one walk a day…sometimes I get lucky and can get two. We will get it fine tuned…it’s just going to take a little time.
The vet is REALLY, REALLY pushing the surgery…I’m not doing Clark long term harm by not opting for surgery…right? You would think it by talking to him.

Anywho, thanks for checking in and the great direction. You idea to crate him at night helped everyone out!! ;0)

I will keep you posted on progress…just might be a little longer than 4 weeks.

Have a wonderful week!

Me:

Ok, so, I’m going to tie in our texts here and I think we should have a recheck to keep you guys on task…so that you see the improvements, and Clark improves, and others may see and reevaluate their insistance on surgery.

In Clark’s case, I don’t hear that anyone is concerned about gross malformation of the pelvis or a femur that is deformed beyond function, so there is no clinical reason to not employ muscle-building & joint strengthening techniques to appreciate improvement. The reports you have given me, verbal from the vet and the view of the x-rays, don’t indicate “horrible hips” and don’t indicate hips beyond the level at which others have improved without surgery. Clark is young. Perhaps your intervention staves off the need for surgery for the remainder of his life or perhaps it serves him well until he is older and then you may re-evaluate.

Usually in a case like this pain control plus the right type of exercise slowly improves the body and therefore the situation.
Some dogs improve, some don’t. The ones that don’t usually have owners who don’t do much of the protocol. So, if they keep doing the same thing as before, they get the same result, yes?

I don’t think you are in that catagory.

You guys represent a lot of families I see in my practice, in that you have two working adults, small child(ren), other dogs, etc…and several variations of this norm exist, of course. This norm is perfect for my home-based protocol because it only causes home-based disruption, in that you only have to sacrifice a little time, and my recommendations are based on 30+ years of my understanding of program design for improved function. This combo brings the biggest benefit, greater results, when all factors are weighed. And there is always the option to pay me to come do the exercise and drill work.
I know you get that

And of course my perspective is a little more broad, because I have seen a lot of what happens to animals in a wide variety of circumstances.

The most predominant point I make to clients is that the protocol does not get easier if the animal has surgery; in fact, it becomes an absolute necessity in order for the healing to occur and for the desired outcome from surgery. Without surgery, using my protocol, there is more room for letting something slip with less immediate ramifications, the main two of which post-surgically would be great damage to the surgery and money down the drain, since re-dos aren’t free (in most cases).

More than that is the additional stress and pain for the animal.

I am writing more here than need be to address you guys directly because I plan to share some of this discourse on my blog and giving more info helps a wider range of readers.

You said you stopped the Rimadyl because it was causing gastro distress…GOOD! And I presume from something you said in your texts that you let the vet know. You were not using the Tramadol as consistently, and I recommended you return to dosing as per the label for adequate pain control and especially since it’s all the pharmaceutical pain control you are using. Don’t forget the fish oil, grain-free food, and the glucosamine/chondroitin/msm…and I think you’re doing all that.

And you wondered if you were doing some sort of long-term harm by not having the hip surgery since the vet and staff seem so insistent on Clark having surgery. I covered this answer in part above. Additionally I will say that the exercise physiology and functional rehabilitation protocol I bring to veterinary rehab are not necessarily new to vet med, since race horses have been using protocol similar to that derived from human sport science for decades. These are, however, new concepts in small animal medicine, it seems. I came into vet rehab after 25 years experience in human sport science and nutrition protocol covering the gamut. These principles were novel where I began rehab practice, and I find the programs I have been designing for humans, based on much research performed by people living long before I came around, also are the most beneficial programs and protocol for animals for pre-hab, re-hab, and instead-of-surgery in many cases. No, you can’t just copy a program from Muscle and Fitness magazine…but you can pay attention and learn what actions produce what results. That will take time. The paying attention and learning…

There are some cases that really may need hip surgery, and when the clients have contacted me for pre or non-surgical intervention, at the very least we may say we are doing pre-hab. In the case of luxating hips, even though keeping the dog in a tight sling for weeks will/should work, as per science and experience, it seems almost impossible for most people to maintain the restrictions necessary for the sling to do its work. Disruption too soon=ligament laxity, again, and the ball of the femur keeps popping out. At any rate, it stands to reason that a body realising better function prior to surgery will improve easier post-surgically. That is also proved in research. Dynamic exercise improves every body system, from strengthening bones to improving the health of soft tissue.

I know for a fact, from years of study, evaluation, and observation, that cross-training rehab specialists in sport physiology and program design for dynamic function would elevate overall rehabilitation outcomes across the board. This has actually been an extreme discussion in Europe for the past yea-many years, that of the need for physiotherapists to have a deep(er) foundation in sports physiology and program design. I haven’t seen it hit here as forcefully yet (and we’re talking human medicine, which is paving the way in this arena). Europe is quite a bit more progressive regarding body wellness treatment and sport program design and a variety of similar topics.

Simply put, these exercises will not change noted gross malformations of the femur in an animal with hip problems, however, to note, any gravity-based exercise, weight-bearing exercise, will improve bone density, so changes along those lines will accrue. These exercises, performed as per a program designed for Clark, should improve tendon, ligament, and muscle strength, muscle size, and neuro-muscular signaling, simply put.

Other beneficial things will happen as well, as always do with exercise of the right type for a particular entity. The changes I noted should improve his overall function. To my knowledge, the surgical protocol is to not operate on hips based solely on x-rays and is to operate based on severity of clinical signs. That is what the surgeons say, and that is what the literature says. Vet surgeons in other parts of the U.S. will not operate on dog hips without having the clients do 4-6 weeks of pre-hab first, with the intent of gaining owner compliance and improving the dog’s health, most especially in cases of obesity.

So, the catch here is to have enough of the right variety(ies) of pain control on board while the dog is performing the best exercises for his/her situation and thereby learning to use the affected limb more freely again. With that increased use come the improvements I mentioned. With the improvements comes the need for less medicine, since increased muscle mass and supportive tissue strength will better support the joint.

That’s all I have time for right now, and I think this will help you guys.

Blessings-

 

 

Possible Torn ACL (Cranial Cruciate Ligament)-How Should We Proceed?

Possible Torn ACL (Cranial Cruciate Ligament)-How Should We Proceed?

Hi Deborah!

I’ve enjoyed following the stories you post on FB about the dogs you heal, and who’d’ve thunk I might one day need your services?

My dog, K, has been gimpy for about a month or so (back right leg)… took her to our vet a couple of weeks ago. By poking and prodding, they figured it’s her knee. Gave us some anti-inflammatories and said to keep her from running, going up stairs, etc. It showed improvement during the first week, but then we let her back on the stairs and it’s back to the same.

My former vet friend, P, looked at it a couple of days ago… She strongly suspected an ACL tear.

I poked around a bit on your site, and it looks like there may be a nonsurgical route for ACL injuries…. I thought I’d ping you and ask you a few questions:

– What would our next step be? (we haven’t had x-rays or the “drawer-test” that Pam described to me)

– If we wanted to do any rehab through you, how would that work and what would the fees be?

K seems very happy and it doesn’t really slow her down too much (unfortunately! She wants to continue being the family dog that she is, around us all the time). Yesterday, we decided to confine her (like crate rest), but the problem is, the gimpiness seems worse after she’s been lying down for a while, then it seems to warm up and work itself out once she walks around a bit. So by keeping her confined, she’s lying on it a lot more and not moving as much, so it actually seems worse. (making me wonder if the confinement is the right thing to do…)

Thanks!!
T

My Answer Today:
Hey Gurl…
Goody…I happen to be home and able to give you a better answer via the pc keyboard!
The best option, imho, is to have me come out and do a consult regarding how you should proceed. It usually takes an hour for something like this. I prefer to see animals for the first visit in the home environment so I may discuss potential pitfalls and see home items we may use for drills, among other reasons. I am also able to do phone consults at $1/minute, but I prefer to see the pet in person…

The second best option is for you to go onto my rehab site and look under notes for the homework for post cruciate ligament rupture rehab.
I also have a video posted on YouTube and my WordPress site regarding a massage technique that is beneficial. The Pittie featured in the video is 3 years out from a cruciate ligament tear and never had surgery. He is doing great because the owner did the homework as I recommended. The YouTube link is on my WordPress and is under RehabDeb if you search it.

I do not think I would ever have surgery on one of my own dogs for this issue again. My little Grace had two TPLO’s, the major surgery where the bone is cut and replaced at a different angle, and both didn’t work out. One wouldn’t have worked out because she had a congenital joint disorder on that knee and the surgery wasn’t ever going to be solid, and on the other knee she ended up getting a raging infection at the time of surgery that eventually ate up the whole joint. The Grace had a poor immune system, and she was open too long on the table, due to unforeseen circumstances, among other things.

She was bone on bone in both knees for the last 3 years of her life, yet she was definitely full of life! She ended up tearing all three ligaments in the second knee, so far as I/we can tell, and it was muscle support of the joint that enabled her to function as well as she did. None of the available braces were of a good enough design for her, and I’m not a fan of what is currently available for most dogs, especially not without working on my walking and exercise drill protocol first.
I deal with many dogs whose owners don’t want surgery for a variety of reasons, and the feedback I receive is that they have done great without surgery.
Of course, I also do rehab with many pets that have had surgery also, from both boarded surgeons and regular vets, using all types of modifications.
I’d be glad to discuss the differences.

We don’t do surgery on every human athlete, much less every human, yet most of the dogs are immediately referred to surgery as if there isn’t another answer the vet knows to suggest. This is because the vets are trained to react in that manner, and they usually don’t have any foundation in muscle-building and joint support protocol. Most of the reasons I’ve heard given in favor of surgery aren’t necessarily scientifically correct, according to available research and anecdotal evidence. I’m trying to make my functional rehab protocol using principles of exercise physiology more readily available.

My background in sport science definitely gives me a huge edge in developing protocol for recovery, and it is just taking slow time, getting the word out and getting people to think more wholly about the situation, and to see/know therapies that exist in other areas of physical science and apply them here. The angle of a dog’s knee, or any quad-ped knee, is definitely different than that of a human/bi-ped, however many principles of physiology and of the relationship between soft and hard body tissue apply and are useful to improve function and quality of life.

Blessings!!

(10-17-13 and now you may purchase the guide book for rehab of this condition at http://wp.me/p1wSDA-cU )

Sully’s Story: Great Dane with Lick Granuloma, Spinal Infection (probable), Paralysis, Ulcer, Pneumonia

I first met Sully March 4, 2011, and you have seen him if you have followed some of my posts about him on Facebook and Twitter. I was first called to see him by a mobile vet and the owner stated as her main concern for Sully at the time, “loss of use of hind legs”. The owner, a woman living alone and not able to easily cope with this just-under-200 pounds-dog who couldn’t move on his own, contacted me on Feb. 28, 2011, and our schedules did not match up until the fourth of March…and by that time he had ceased to be mobile and had been stuck, lying on one side, for several days.

The short story for those of you with attention span issues is that Sully couldn’t walk, had a lick granuloma that was about 2 yrs. old, had likely incurred spinal infection from the infected granuloma site, had several urine burn ulcers, developed pneumonia, was treated for pneumonia, which, in turn, developed into long-term treatment for possible spinal infection, was treated for pain, was pushed daily to move in increasing amounts, and is now walking down the street with no assistance.

A case outcome like this is relatively rare, primarily because the owner has stuck with treatment (it works if you work on it and give it time…), and usually a case like this would have been euthanized because he is huge, the owner did not have additional help in the home, he is aggressive, and the owner was not going to have him hospitalized for any reason-not for pneumonia, not for machine-based diagnostics, not for urinary incontinence, not…period.

Sully definitely had some dark moments, yet everything that has happened with Sully has been “do-able”, maybe not optimal by  some of today’s standards, yet definitely “do-able”. I have pushed Sully, the vets, the owner, and any other caretaker every inch of the way to drive us all to give Sully the best treatment we all could…it has definitely been a collaborative effort, and I knew from my background and experience that experiences like ours with Sully were/are very novel to the majority.

Silly Sully

Thank you for your attention thus far, and blessings…please take any of the following info and use it to heal in your corner of the world.

Two block-and-tackles, a belly sling, a saddle girth, some caribiners, and a hind end sling…gets the day going!

April 7, 2012

Today is Sully’s 10th birthday! I have been working with him for one year and one month. A year ago, he couldn’t stand on his own and was sporting a urinary catheter. Last week he tried to run down the street with me! We love us some Sully!

Walk Slow or Walk Fast?

Q&A –

Should your pet be walking slowly or walking faster after injury or surgery? Science says slow and steady –

Question –

“Dr. *Surgeon* did X-rays and said she is totally healed. He said sometimes the implant can be irritating for her and he can remove that since the bone has healed…could be the reason for some of her discomfort. He also said slow walking is more painful for her and she should go at a faster pace. What do you think???”

Answer –

Yes, walking slower is more painful because she is having to use the injured limb more.

She has to use the injured limb more for good recovery.

It is also painful when the pet is not receiving enough pain medication to go along with a proper home rehabilitation plan.

She needs to use her leg for full healing.

If your pet is going fast, they are usually skipping over using the injured body part, whether you think you see them doing that or not. If they don’t use the painful body part, they won’t grow bone & muscle as well or much at all, and they won’t heal as well. They cheat on leg use when they go fast after injury or surgery and if they are in pain, which they most often are in my experience.

Pets don’t use the affected muscles & limbs like they should for better development and recovery when they are in pain. Proper dosing of pain medicine goes a long way toward encouraging healing and making the system work better.

I do not agree that she should walk faster; it defies sports medicine principles and the principles of functional recovery and rehabilitation to have her walk faster now. A slow return to positive function will most likely insure against added injury.

Here is a booklet to help after surgery or with most basic recovery for the first four weeks. Real rehab should be progressive and will last at least 12 weeks on average. Persistent problem cases may take up to a year or more to heal more fully. This is the same as in human medicine. 

 

Published August 13, 2011. Updated May 3, 2018

Today’s Question: Torn Meniscus? Tearing CCL?

Hi Deborah! (My son) and I are in Canada with our dear friend J. J. has two border collies…one about a year and a half and one about 8 months. I have a question I’m hoping you can help me with. Any advice would be most welcome:

The baby (Morfydd) began limping several days ago. I would classify it as a mild limp. We took her to the vet and the vet diagnosed her with a pull cruciate ligament. (She attempted a drawer sign and felt a little click on that side accompanied by Morfydd indicating discomfort). She said that it was not a tear but a pull. She prescribed a modified version of your house arrest: No running or playing, only walking slowly on short leash, no walking up or down stairs, swimming okay if carried in to deep water. She also prescribed a NSAID- not Rimadel but something similar. She suggested doing ROM three times a day, daily comfrey as well as Reiki. (They are WAY more progressive here!) Here’s the problem and I would love your feedback if you would be so kind:

It is truly impossible to keep her down like that. Her “big brother” is a full energy dog and they play all the time. We would need to keep her crated all day which simply isn’t practical or possible. Yesterday I kept them separated much of the day, but then she was so cooped up that when she would play, she would go nuts and play harder than ever. Her limp doesn’t seem that bad at all- nothing like what (my dog) was like. Gosh- I hope I’m explaining this adequately.

Our question to you: Is there a way to deal with this with some care but without this level of restriction? Can a pulled ligament heal without this level of rest? Without exercise, she seems destined to injure it further due to play that is more… unbridaled, if you know I mean. One piece of info I should add is that she is on the thin side and her muscles are a little underdeveloped so we are trying to get her fattened up a bit. She is getting glucosamine added along with fish oil already. She is on a mostly raw diet. She refuses vegetables so we have been trying to sneak those in with limited success. Okay, I’ll stop now. Tell us any and all that you are willing/ able to. Thank you SO much in advance, dear Deborah!!!!
xoxoxoxo,
S.
p.s. I hope this makes sense!!!

MY ANSWER FOR TODAY:

Now, several options…
First, regarding diagnosis (dx): a click often means meniscal damage. A torn meniscus is different from a torn/tearing/ruptured cruciate ligament (CCL dogs/ACL humans). This may not be what is going on, however I am more familiar with a click=meniscus than a click=ccl-only damage when performing drawer motion. Drawer motion is designed to reveal what it suggests; the tibia slides forward like a drawer opening, and if it does, to whatever extent it does, damage to the CCL is indicated. Meniscal damage may only be rectified by surgery (sx), to my knowledge, and it is problematic and painful to endure, to my understanding, without sx. It is like having a sharp rock in ones shoe, on the one hand. The corrective sx for torn meniscus, on a positive note, is usually arthroscopic and, therefore, less invasive than a full opening of the knee.
I agree with the vet’s prescription regarding structured leash walks for exercise, and you may better structure it by following my plan (available on this blog) for conservative and/or for post-sx CCL tear homework.
EXCEPTION to her recommendations is that swimming is NOT A GOOD IDEA; swimming with a damaged knee usually causes more and different damage, particularly potentially patellar tendonitis, and that is if they use the hind legs to swim at all. Dogs do not tend to swim using their hind legs in plane, which would be optimal, imho; instead they give thrusts laterally, or more laterally, and this potentially brings the additional damage.
I also see no point that is largely beneficial to performing ROM, and although that is what the vets are instructed by the powers that be in the dominant paradigm to instruct owners to do, it makes no practical sense in a case like this. Morfydd is able to move her own leg and will do so fully so long as she is not in pain. Period. People run the risk of damaging the dog or, at least, wasting time and activity on ROM when more beneficial activities may be pursued.
Reiki=good, comfrey=ok…I would add fish oil and Arnica Montana 30, along with the type of massages I also recommend in my video on this blog. I re-read your note and see that you have fish oil on board, so see that you are in a good dose range…fish oil, probably ~300-400 mg EPA (and concurrent DHA), daily, in capsule form, which you may puncture and squirt onto food. I usually place the punctured capsule in the food dish as well. Your Cozzie likes to squish them whole. Either way. :)Potentially good that she is on other joint protective (glucosamine, etc…) also, depending on the brand and dose. I appreciate that M. is fed raw, however it may be, since she is not eating her veggies, that introducing a grain-free canned (for the crack-appeal, immediate gratification) and eventually grain-free kibble would be a good idea for her juvie self. I have utilised many brands and find consistent beneficial results with Wellness Core. Unfortunately they don’t pay me to promote their product. 🙂 Grain-free seems to be the best option regardless and based on much science, especially results of studies that indicate that grains are implicated in joint dz (disease) and autoimmune dz.
Consider this: there is no option for recovery outside of recovery…so, if y’all don’t keep her quiet so we may see what the more true nature of the damage is and/or dx toward next tx (treatment) options, then she will continue to damage her joint and it will get worse. If she had sx, then she would have no option but to be quiet for recovery.
So, regardless of how you perceive the dynamic, restriction is entirely possible. I see all sorts of animals and homes and owners with varying psychology, and most people resist restriction on behalf of their animals and their projections as to what they think the animal will be “happiest” doing.
Just sayin’.
She should be restricted and NOT ALLOWED TO PARTICIPATE IN POTENTIALLY DAMAGING PLAY, yet entertained by structured walks, wherein you project to her that this is an important job, and then entertained by mind games, i.e., guess which hand the kibble is in, guess which cup the kibble is under, etc…
I do understand that some breeds need more stimulation.Try her on restricted leash walk, 5-10 min, going over a short cavaletti course. This will give her a project, naturally induce greater ROM, and help her “feel” satisfied for having completed a task. Short as in height, perhaps 4-6″. Go over cavs 10-20x.

You won’t kill her either way…you will just induce more pain and potentially she will have to live with pain J. doesn’t recognise for the remainder of her life, will live on higher doses of pain meds (which may be unavoidable in some cases, like my Grace), and/or will need sx. So, being more conservative in the short run may bring gains for the long run. Most people do not think their pet is in pain, and most people do not know the additional signs I see when I evaluate the pet.
This advice coming from the queen of noting that shortcuts usually don’t work.
Luvsu.
Let me know if you have additional questions.
Think practically, intuitively and spiritually with less projected emotion and you will likely do well by her.
That will be a thousand dollars. You are welcome.
xox

3/17/13 note: this dog is doing fantastic and most of the homework suggestions were followed.