About Exercise Physiology-Based Veterinary Rehabilitation, Rehabdeb, Rehabilitation and Conditioning for Animals, and Move2Live
As you may have seen on social media outlets, our Moving2Live interview about Rehabilitation and Conditioning for Animals is now live on the Moving2Livewebsite.
The interview discusses my background and exercise physiology-based veterinary rehabilitation. You may also find the podcast on Apple Podcasts, Google Play, Stitcher, Spotify and other platforms by searching “Moving2Live.”
Move2Live has posted on Instagram, Facebook, Twitter and LinkedIn, so you may find the podcast there. I’m posting on all of my social media outlets as well, so you may find the podcast link there.
Please subscribe to the show on Apple Podcasts or your favorite platform, and please write a review!! This will help the interview get found by others.
You probably already know how the internet works regarding “getting the word out”. Please spread the word if you have benefited from this rehab. It’s a great idea to share the interview with co-workers, friends, and family! You never know who needs the help or who knows someone else who needs rehabilitation and conditioning for animals.
If you follow this exercise prescription well and would like advanced exercises, then contact me for a consult. There is a contact form at the bottom of this page <<Click on link . Use this form if you would like to schedule a paid phone or in-person consult with me for rehabilitation for your pet.
I have frequently seen cases where veterinary surgeons performed these two surgeries at the same time, on both knees, so a quadruple whammy. On the one hand, reasoning for doing so includes such thoughts as, “You only have to put your pet (usually a dog) through anesthesia and surgery one time”, and “You *only* have to go through recovery once”, and “We might as well do both surgeries once we open the knee”.
For now, I will tell you basic functional details of this case without the additional info I’d report in a formally published case study for a journal. I’ll put all the additional info into my booklet when I write it.
Feel free to ask questions.
This particular client found me after her dog’s surgery, having been referred to me by a groomer. The client, like most, was at a loss as to how to handle what was a very fragile situation with her best buddy.
Within the first 2 days of working with this little cutie I noticed tissue swelling, redness, and heat in one knee. The other leg was limping along in a fairly average recovery yet also not seemingly infected.
I typed reports, including extensive details about the signs and symptoms of a possible infection in one knee post-surgically, and I faxed them (years ago when we used fax more) to the hospital for the surgeon after my first visit with the dog.
The surgeon didn’t respond to me regarding my observations so I guided the client in solid restriction protocol, including how to help her dog potty, while she waited for her recheck appointment. I also thoroughly explained to the client the discussion she should have with the surgeon or her regular veterinarian to get the knee re-evaluated for possible infection asap and/or rule out other post-surgical complications.
Infection or Activity Level?
At the time of the appointment, instead of recognizing infection, the surgeon offhandedly blamed the owner and rehab for doing too much, saying that was why the knee was red and swollen. I assure you, Dear Reader, that neither the client nor the 1st week of rehab recovery was the problem…not at all! I emphasize this so that if you feel strongly about your or your pet’s health, you don’t feel intimidated when you pursue answers for healing. Politely speak up for yourself and for others. Try to build a bridge while not settling for any answer that belittles you or your thinking, if possible.
Recovery Protocol –
The client had gone above and beyond regarding securing the best recovery she could for her little dog. She frequently worked from home, a multi-level home, and she purchased baby playpens as good recovery pens for her fuzzy kid and put them on each level and in at least one room on each level. The dog was confined to the pens or to a crate.
The client originally hired me to come daily and strictly perform my very basic first week recovery plan just so “it would be done right”. I assured her that the plan was so simple for the first four weeks that she would not mess it up and that she could do it herself, but she really wanted me there daily.
The client was incredibly attentive to *doing everything right* and wanted me to do all the work except for potty breaks and other relevant work I couldn’t perform because I didn’t live with the dog. That turned out to be beneficial for the dog, since I caught signs of infection early.
Outcomes and Results –
The surgeon did not return my communications regarding the signs I noted that pointed to a problem that was likely infection in one knee. He also made the client to feel inadequate when she most very likely had nothing to do with the onset of the infection (based on preventative measures & type of infection), and she did return to have the surgeon address the issue, as anyone should.
You, Human Reader, should have your concerns addressed without your being made to feel inferior by the surgeon. Just so you know that’s a potential great outcome from the encounter, should you have one.
Soon thereafter, the pin the surgeon had placed in one knee as part of the patellar luxation surgery began to remove itself from the knee due to the infection and swelling. The pin notably moved out of where it was placed during surgery to a place that was easy for anyone to feel it poking out.
The client and her regular veterinarian were both timid with regard to “going over the head of the surgeon” and didn’t want to “step on toes” by addressing the now fairly obvious infection. This does happen fairly frequently in some communities.
Activity and Pain –
The Yorkie was in so much pain that he wasn’t trying to bounce around or get out of his confinement(s). I’ve never seen a dog that received this quad-whammy surgery bounce and try to play soon after surgery. They are usually very subdued by the pain of the surgeries. Also, bouncing and playing on a post-op leg usually produces a different type of swelling than infection swelling.
It is my opinion that we need better pain controlfor our pets . We do for humans, too, and you may already know that. Help for pain, especially nerve pain, has been a fave topic of mine for decades.
Is it an Infection?
I have also found that it is often hard to determine whether or not infection is present. We (client & care team) discover sort of anecdotally most of the post-surgical infections I see in cases. These infection areas are not hot and do not cause tissue swelling. These infections are causing pain in the joint. This pain doesn’t go away with combos of the right amounts of the right pain medications.
Dealing With the Infection –
When I suspect infection in a post-op orthopedic case, I recommend the client and vet discuss trying an antibiotic. I base this recommendation on something I learned in about 2006 from a surgeon. I always tell them that it was the surgeon’s idea, not mine. If the limping stops around three days after beginning abx, it is likely that we’ve found infection causing the pain.
I can’t legally diagnose infection, however I may share information about infection and potential treatments to inform the client. I also easily have many conversations with veterinarians to share what other vets might have done in a particular situation. That is collaborative work.
Of course antibiotics are considered only after ruling out the other usual pain scenarios (not enough pain medications, destroyed surgery, etc…) and/or medical reasons the pet cannot take antibiotics. Often this abx (antibiotics) dosing is the cure for continued limping if all else seems okay. I have shared the info from this surgeon with many veterinarians in my area. It has helped a lot of pets.
Usually I also tell the pet’s regular veterinarian about the many situations I’ve encountered where antibiotic treatment has produced the pain relief we hope for. In these cases it has eliminated an infection that wasn’t even suspected. I cannot legally diagnose any medical issues, but I don’t hesitate to relay my findings and experience to veterinarians. By doing that, sometimes we all get to learn and collaborate.
This infection was not the fault of rehab nor of the client and possibly not the fault of the surgeon. Infections like this are actually a common occurrence. I cannot say whether or not this infection could have been avoided. In my experience it seems very difficult to avoid infection under certain circumstances. Let’s just recognize it and deal with it medically on our ends, because we are working after the fact.
If there is swelling in your pet’s knee (or other body area) or if it is hot and red after surgery or injury, please go to your veterinarian or veterinary specialist and have it evaluated sooner than later.
…and the Pin?
This Yorkie’s infection advanced quickly. The surgeon removed the pin from the infected knee after the dog finished a course of antibiotics. In the meantime, the infection did its damage. This Yorkie never gained as full a use of the infected leg as he did in the other leg.
“That’s What I Thought!”
If you feel like your pet has a problem that the surgeon or veterinarian is ignoring, then please go ahead and get a second opinion from another licensed veterinarian. I post information about cases like this because I receive many, many emails from all sorts of people about their pet’s cases, which are similar to what I frequently encounter in my practice. I want to give strength to your voice if you are trying to get to the bottom of a problem with your pet and aren’t sure to trust your gut.
What Else Helps With Infection and Infection Pain?
Ice will not do much to help infection swelling and pain, in my experience and according to research. Usually other time-consuming therapies don’t get rid of the infection, and therefore the pain, either, and waiting for them to help with pain allows the infection to cause additional joint and tissue damage. Bacteria are causing the pain in the case of infection pain and have to be killed for the pain resolution.
Anti-inflammatories and narcotics don’t usually help against infection pain and they don’t kill the infection bugs, either. I never recommend heat compresses or dry heat in general right after surgery or injury. I base that idea on decades of published research that practitioners still argue about. Sometimes heat and/or ice are the best idea, but only in specific cases and not across the board. Sometimes moist heat is great for certain infection cases AFTER infection diagnosis.
Ultimately, there is no “blame” here, especially since that isn’t productive in this case; what there is, however, is discovery and learning through experience. Ultimately the pets health (or yours) needs you to be the best advocate you can be. Trust yourself if things don’t seem right, and push to find a practitioner who listens and collaborates.
There is a contact form at the bottom of this page <<Click on link . Use this form if you would like to schedule a paid phone or in-person consult with me for rehabilitation for your pet.
Ligament Structure, Injury, and Recovery for Your Dog or Cat or Other Pets-
Former title: Stifle (Knee) Ligament Ruptures (Torn ACL, CCL) Information Overview and Ligament Injury Recovery.
This is a piece I wrote as an overview of torn knee ligament originally in 2007 for a client of Dr. Dennis Sundbeck, DVM, owner and practitioner at Round Rock Animal Hospital for 35 years.
Dr. Sundbeck retired in 2014 and passed away April 15, 2018. Our community remembers him fondly as we celebrate his life and contributions to many aspects of Central Texas.
I remember Dr. Sundbeck specifically and warmly because he was possibly the first established, old school, veterinarian in my area to refer a case to me for non-surgical recovery of a torn knee ligament in a dog. I do not think he and I had been able to talk prior to the referral, however he must have read the materials I dropped off at RRAH when I began my business in January, 2007. Evidently my methodologies made common and scientific sense to him.
I have always held that situation deep in my heart as a beacon to support my work to switch veterinary medicine off of the all-too-quick referrals to surgeons for injuries like torn ligament, torn meniscus, and “bad hips”. RRAH continued to support my rehabilitation practice over the years and often supplied my recovery booklets for their clients.
This post has information about ligaments, ligament injury, surgery, and some guidelines for rehabilitation. The homework protocol I have written for use after surgery or instead of surgery and which has been used successfully for years is now available in book form, and here are the links: rehab books on Amazon.
What Are Ligaments?
A torn ligament is not a life or death situation in and of itself.
Ligaments are dense connective tissue structures consisting of fibroblasts, water, collagen, proteoglycans, fibronectin, and elastin that connect two or more bones (1, 2).
What Happens When My Dog or Cat Tears a Ligament?
Within hours of injury, the defect (injury) is filled with an organized hematoma and the surrounding tissue becomes edematous (swollen with fluid) from perivascular leakage of fluid. Monocytes and macrophages are found in the wound by 24 hours and respond by cleaning up the site and transitioning to the next phase.
How Long Does The Injury Last?
The acute injury phase lasts about 48-72 hours (2). The knee will swell, sometimes only a little, inside the joint. This makes the bony parts thicker or expanded due to fluid accumulation inside the joint. This is called effusion, and it is part of the healing process. Sometimes the knee (stifle) swells a lot inside the joint. Other times there is swelling in the soft tissue as well.
Does My Dog’s Torn Ligament Heal?
At this writing, a great deal of information remains unanswered regarding timing of ligamentous healing in canines, especially with respect to postoperative mobilization techniques (graft, suture, TPLO, TTA, CBLO, etc…). This is because ligaments heal differently depending on the location.
For example, the healing potential of the medial collateral ligament of the stifle is very good, but the cranial cruciate ligament, which has received the most investigation, demonstrates virtually no healing response following injury (2).
What Will My Pet’s Veterinarian Do?
Your veterinarian will most likely watch your pet walk, manipulate the injured limb and joint, and take an x-ray, radiograph (rads), of the knee or other injured area. Please do not protest the x-ray.
You are correct if you already know that we cannot see a torn ligament, per se, via x-rays (rads). What we can see, however, is cloudiness where the swelling I mentioned above is happening.
We may also see whether there is what I call a 1% issue in the knee or surrounding area. Sometimes there are hairline fractures at the tibia or growths that are irritating the leg or joint that we are able to see on rads.
I have seen a lot of what I call 1% cases in my practice, and I won’t take time to cover that here. Get the x-ray to see if your vet sees what they think they’ll see if they recommend an x-ray. Clients ask me to explain the need for the x-ray *all* the time.
My Vet Said My Dog Had to Have Surgery –
A ligament rupture is not a matter of life and death.
Many people come to me saying that they have felt forced toward surgery for this condition in their dog. In contrast, I’ve had client “body specialists”, some of whom are human medical doctors, with a different opinion. One in particular said, “I wish we could get people off of the surgery idea! We don’t even rush every human athlete into surgery, much less every person in general.”
Slatter’s Textbook of Small Animal Surgery states that small dogs often do well without surgical intervention, and that based on particular studies, “it is prudent to wait for at least 6 to 8 weeks before recommending surgery for small dogs. These dogs are older at diagnosis and are often obese with concurrent medical problems. Small dogs that are lame for 6 weeks after diagnosis and show no improvement often have meniscal tears and are operated on for meniscectomy and joint stabilization.” (pg.1832)
Believe it or not, I have had clients who were told they’d need to euthanize their pet for this injury. Recovery without surgery works. If you cannot afford or do not want surgery for your pet, you definitely do not need to euthanize them because of this injury.
Drugs and Surgery Referral –
It is at this point that most veterinarians will recommend an anti-inflammatory drug for your pet and a consult to a veterinary surgeon.
If you are referred to a surgeon, there is a possibility that the surgeon will want to take their own rads. They usually do that if the originals did not come out as well as the surgeon would like to see and if they think there is something else worth seeing. I have been with surgeons in the room at the time of consult, and sometimes they say that “there’s no need for x-rays because you cannot see a torn ligament on x-rays”, and sometimes they want an x-ray.
Some veterinarians will know of my programs and will refer people to them. If you want to see a few of the testimonials for my programs, from vets and clients, click here.
Some veterinarians will have clients keep their pet restricted, with or without medications and without referring to surgery. There are many, many ways medical practitioners deal with injuries, and there is not one set method. Above are the top three situations I meet. Here are the first three steps I recommend after injury.
Practitioners often recommend ice during the acute phase of injury. The standard recommendation is 1-6 times per day, for 20 minutes each application, on average. The duration of application depends on fur density on the pet and type of ice used.
I have a separate paper with icing recommendations on this site if you really feel that you need to use it. The method of delivery most recommended by others yet one of the least effective is frozen veggies, so check out the other options noted in my post.
More research in recent years shows that stopping the inflammatory process is not a good idea much of the time for this type of injury. The body may heal faster If we allow it to go through the natural inflammatory process. It also helps if there are pain medications like Tramadol or Gabapentin available. Ice and nsaids work against inflammation, and therefore also work against healing.
Should I Use Heat on the Injury?
This question is often in debate. Here is a link to a recent paper on the subject. I recommend that you NOT use heat on your or your pet’s injury unless you have read the recent science. In my experience, people want to use heat when they should be using ice. They usually don’t know how and when to use heat to help with healing. Check out the above link for more info.
Laser Therapy and Acupuncture –
Throughout the healing process using low-level laser therapy is a good idea if it is available to you. I use a class IIIb laser in my practice, and I have attended two national and world conferences on laser therapy. See these sites for more info: WALTandNAALT.
I haven’t yet posted much on acupuncture, so here is a random PubMed search link to papers on acupuncture for healing. I use laser therapy over acupuncture if only one option is possible. This is because of the added benefits laser therapy provides over acupuncture. USA law says if anyone is going to acupuncture your pets, it has to be a licensed veterinarian.
Acupuncture and laser therapy both work in manners that most people don’t necessarily understand. Acupuncture can be very effective for short-term pain relief. I rarely come across a human account of pain relief from acupuncture lasting more than a day. Acupuncture is also a great treatment for other conditions.
Laser therapy (LLLT) is effective for short and long-term pain relief. LLLT also stimulates cellular growth and production and it also breaks down scar tissue. Short story. Check out the websites I linked above for more information.
I do not recommend throwing the kitchen sink of vitamins and supplements at any injury, illness, or chronic condition. I recommend using specific, limited ingredient, supplements for specific conditions and expected results.
Ligament Support, Arthritis, and Instability –
In many cases, loss of ligamentous support invariably leads to progressive osteoarthritis, such as in cranial cruciate ligament (ACL) ruptures. Osteoarthritis will continue, even if you choose to have surgery. Another interesting paper from the “human side”, because the research on athletes and other humans is better than what we have available for advanced recovery protocol in veterinary medicine.
Most veterinarians learn in school or conferences that the pet is not using their injured limb for psychological reasons. I believe the greatest reason that humans and pets are not using a body part is due to pain. I discuss this more in this post. Instability also plays a small part in leg disuse.
Surgery Does Not Stop Arthritis –
Please understand that the arthritic process began when the first injuries occurred in the joint, when damage first occurred and then when tearing began. It is most likely that you know nothing about when the arthritis actually began to develop. A ligament usually will tear for some amount of time before total rupture. Sometimes people use my programs at first notice of injury, prior to a full ligament rupture. Most of those pets do not go on to fully rupture their injured ligament.
So What Does Surgery Do?
Clients tell me that veterinarians and others tell them that surgery will stop the arthritis. This statement is similar to the truth but it is not altogether true. Surgery immediately stabilizes the joint. Surgical stabilization can help keep the knee from moving incorrectly. In turn, that helps keep the joint from further damage.
The right exercise protocol after injury ALSO helps keep the knee (or other damaged joint ) from moving incorrectly. Moreover, the right exercise protocol strengthens the muscles of the leg with the damaged joint and keeps the other limbs from overloading and becoming injured, too.
By the same token, braces are not a more permanent fix for torn knee ligaments. They are no substitute for good recovery drills and exercise to gain long-term quality of life. Veterinarians and clients ask me about braces *all* the time. Here is my braces post.
Active Recovery –
Your pet needs an active recovery program correct for their status and situation, whether or not they have surgery. If your pet does not do an active recovery program, their muscles will not develop as well as they could to help stabilize the joint. Use my or a program designed by someone who has experience with exercise physiology, professional physical recovery techniques, and veterinary rehabilitation.
Moreover, your pet is likely to tear the ligament in the opposite leg if they’ve already torn one. My strong belief is that the opinion about the high likelihood of a dog tearing the knee ligament in the other leg after tearing the first ligament is based on poor recovery techniques. One day, I hope to run a study proving this.
Excessive exercise during periods of acute joint inflammation may be harmful to articular cartilage. (4) Greater stresses that are placed on the joint in the presence of ligament damage will cause joint damage. NO running, jumping, playing, etc…
Meniscal Tear, Too?
Your veterinarian may help you check whether or not your dog has a meniscal tear. If I am working with you and your pet, I can point out sounds and other signs that may indicate a torn meniscus. If we find s&s, you should follow up on that with your veterinarian.
It is also not necessary to have surgery for a meniscal tear. My programs for dogs with torn knee ligaments work for meniscal tears, too. I had an MRI of one of my knees several years ago to find out what was going on in it. It turns out I had already non-surgically worked through a very old meniscal tear of my own!
Keep in mind that the recommendations I cited from Dr. Slatter’s textbook do not include a return to function plan. Slatter’s instructions are most likely based on the fact that many dogs have improved over time without any specific intervention. If a thoughtful and proven programis performed, the dog or other pet should recover all the better!
You may do all recovery for torn knee ligament or meniscus injury or surgery in your home environment. If you need to, enlist the help of technicians and vets at your pet’s clinic while using my programs.
What About Giant Dogs?
Additionally, I have used the same basic and advanced functional rehab protocol for large dogs. That is because successful programs are based on principles of athletic training and recovery. These will best address joint instability and muscle atrophy that occur along with knee damage in giant breed dogs.
My Great Dane, Grace, was the most orthopedically-challenged pet I have known. Without my rehab, she probably would have passed on at half her life of 11.5 amazing years.
Muscle atrophy usually occurs during the whole time the pet has been injured, prior to intervention. This is because the injury will have usually produced pain and instability, even if mild at first. Pain and instability encourage disuse and, therefore, muscle atrophy.
The degree of quadriceps muscle atrophy present before surgery for cranial cruciate ligament (CCL) rupture seems to correlate significantly with the degree of cartilage fibrillation, indicating a relationship with the severity of the condition. I refer you back to my info on pain and instability.
In studies, muscle mass improved 7 and 13 months after surgery, but significant residual muscle atrophy remained in many dogs even after 1 year. Muscle atrophy usually reverses in much less time when owners have followed my recommended protocol. I have also worked with many patients that have not previously regained muscle mass after injury or surgery. I have been able to correct the imbalance in most instances.
How Will Rehabilitation Help Ligament Injury Recovery?
A specific exercise program with frequent changes in protocol will indeed build muscle. It will also usually cause hypertrophy better than surgical repair alone or pain medication alone. I realized this first based on my observations in practice. There is also a lot of substantiating research on the topic(s). Try the National Strength and Conditioning Association for foundations in strength training if you have further interest in this specialty.
For non-surgical and surgical patients, rehab treatment may consist of conservative exercise that increases in difficulty as healing progresses. Both should receive therapies such as I have mentioned plus weight control plans.
For non-surgical patients, building muscle and supporting tissue will be important toward stabilizing the nearby joint(s). We also want to keep up protective interventions for affected joints. Use the therapies mentioned above and keep up dosing supplements and pharmaceuticals proven to aid with function and recovery. Nutrition supplement support includes glucosamine/chondroitin/MSM, Arnica Montana 30, and fish oil, among others.
Rehabilitation Practitioners –
A qualified rehabilitation practitioner should be able to design a basic appropriate plan of action. They and your pet’s vet can collaborate to meet your pet’s needs for recovery in the home environment. It is within the scope of this paper to briefly give information regarding ligament damage. I also inform more specifically on basics of rehabilitation recovery.
There were no written protocol that I could find that addressed specific exercise protocol and return to function for small animal veterinary medicine when I began professionally practicing in veterinary rehabilitation in 2004. This was especially true for ligament injury recovery. I subsequently began writing protocol based on how similar human injuries are managed and treated for athletes. This method has been very successful and very helpful to large numbers of people and pets.
1. Fowler D: Principles of wound healing. In Harari J, editor: Surgical complications and wound healing in the small animal practice, Philadelphia, 1993, WB Saunders.
2. Frank C et al: Normal ligament: structure, function, and composition. In Woo S, Buckwalter J, editors: Injury and repair of the musculoskeletal soft tissues, Park Ridge, Illinois, 1991, American Academy of Orthopedic Surgeons Symposium.
3. Moore KW, Read RA: Rupture of the cranial cruciate ligament in dogs. II. Diagnosis and management, Compendium of Continuing Education Pract Vet 18:381391, 405, 1996
4. Agudelo CA, Schumacher HR, Phelps P: Effect of exercise on urate crystal-induced inflammation in canine joints, Arthritis Rheum 15:609-616, 1972
Final Notes –
By the way, that case? From my prologue? Was a 2 yo in-tact male Chocolate Labrador hunting dog with extreme crate anxiety and parent-clients who both worked long hours in science-based jobs. I remain forever grateful for that referral.
And I continue to receive support from RRAH and Dr. Sharon Waters, most specifically, as they work to provide the best care for their patients.
(Copyright 2007, Deborah Carroll, Updated April 18, 2018)
I have read the homework and this is a dumb question, but I do not know where to put the ice on an ACL tear.
I would like to have an evalution to see what I can do to make my guy better. He has started limping more and I want to start using the ice. He does not seem to be in any pain at all and I do not have him on any meds except a chinese herb which is not helping. I will be setting up my work schedule tomorrow for the upcoming weeks. Is it possible for you to evalute my boy?
Not a dumb question at all…for now, you may just place a pack directly on his knee, on the side, while he is lying down. Leave on the pack for 20 minutes, no towels or other barriers, especially if he has fur…that is enough of a barrier.
Yes, we may set up an appt. I have some openings next week, and I will write you mail this weekend to set up a time and day. Thanks-
Oh, and if he is limping, he is likely in pain.
It is common for most people, even people with medical training, to think for a variety of reasons I won’t take time to discuss here that the animal is not in pain, however the best demonstration that he is in a little pain, at the least, is usually limping.
I suggest you speak to the vet about getting an anti-inflammatory or another pain reliever, like Tramadol (used a lot here in Austin, TX), if you are open to that idea, and if you are not, we will talk about some other options when I see him for evaluation. There are usually not any combinations of even several non-pharmaceutical helps that will do away with the type of pain that is enough to make the patient limp. This means you usually need pharmaceutical drugs to help your pet feel better, feel less pain.
Also, if you do give a pain reliever for a day or two and the limping stops, that is another good clue that the limping has been due to pain. For more information on pain, please see my pain posts by searching the word pain in the search box.
I also highly recommend fish oil capsules…they are anti-inflammatory, for one, and good for many things. Look for a capsule with 1000 mg of oil or less and definite amounts of EPA and DHA, noted separately on the label. A good place to start is about 20 mg of EPA daily for every kg of body weight.
Last week I evaluated another dog with persistent disuse & pain after CCL surgery ( for torn ACL / CCL).
Here is a copy of the synopsis I sent via email to the owner and to the vets. I had already made a phone call and left a message with one of the treating vets.
As promised, here is a bullet point email synopsis of our visit today. I am also sending a copy to Drs. Txxx, Exxx, and Wxxx since they have all been treating Dxxx. As I texted to you, I did contact Dr. Txxx after our visit, and I left a vm for her, trying to detail what I thought was going on with Dxxx. She and I subsequently texted a bit and she noted that she gave Dr. Exxx a heads-up since he is the one who did the surgery and since you may be contacting them tomorrow.
Dxxx is able to walk on sx limb and often chooses not to do so. He is 2-4/4 lame; 2 at a walk and 4 when faster. He is quite atrophied in L thigh, especially lateral. He is 7/9 PBS with substantial fat pads over both hips, adding to the deformed appearance of L hind. Fluid sac exists at L lateral stifle and you said the vets were aware of it and it was deemed a fluid collection related to suture. Mild to moderate effusion in L stifle, and I worked with owner so that she could feel it and become accustomed, able to tell in the future if/when it subsides. Dxxx has not consistently been receiving pain meds recently.
At this time out from surgery I would expect Dylan to be consistently using L hind and atrophy to be (mostly) resolved, no effusion.
1) Begin dosing analgesic this evening. You may use Metacam as previously directed and so long as his liver values are fine. You may use Tramadol as scripted on the bottle. We discussed the mechanisms of both drugs and the potential benefits/drawbacks. If his lameness is not resolved using these analgesics and/or possibly using the Gabapentin that you also mentioned he has been scripted, then you are to contact the vets no later than 2 days from the time of pain med dosing to discuss the possible use of antibiotics and let them know of the continued disuse on top of medication dosing. I have seen many cases like this that have persisted in lameness and had mild effusion (or no effusion) in which existed a low-grade, latent, painful infection. In these cases, depending on the antibiotic the vet chose to utilize, the lameness was mostly or fully resolved within two days, usually at the end of one day. Given Dylan’s dynamics (licking busybody), it is highly possible that this is what is occurring. The vets in other cases I’ve worked have chosen to dose the meds and not tap the stifle joint because the meds are relatively easy and the joint is then not disrupted nor the chance of new infection introduced. I touched on these ideas with Dr. Txxx, and I do not know what she passed on to Dr. Exxx, however they will discuss it further and will likely want to have a look at him if they have not seen him in a while. Please do not hesitate to call them sooner than in two days, and I’m sure they will be glad to talk with you or see you.
2) I recommended you follow this link: http://rehabilitationandconditioningforanimals.wordpress.com/category/homework-suggestions-for-functional-rehab/ to my “Homework for After Knee Surgery” and read it thoroughly. Begin working Dxxx at week 1 two days after most of the lameness has improved. Again, I expect the disuse to resolve with either pain meds or antibiotics or both, and in my experience it will resolve within two days of the medication that hits the problem.
3) Follow this link: http://rehabilitationandconditioningforanimals.wordpress.com/category/qa/ to Q&A about limping and knee pain after surgery.
4) Follow this link: http://rehabilitationandconditioningforanimals.wordpress.com/2011/07/30/water-treadmill-is-definitely-not-necessary-for-rehabilitation/ to more on joint pain, water treadmill, and rehab work.
5) Slowly reduce treats and a small amount of pm feeding. Measure the food he receives currently so that you are able to control the amount you reduce. Losing the extra fat will help with his function and protect his joints. Lots of research exists regarding this concept.
6) Begin giving ~200 mg EPA and ~100 DHA in fish oil daily. This amount may be doubled. You may use the brand you have or some from (the clinic).
7) Please keep me posted regarding his progress with the different meds. We will recheck in one week. In the future I intend to discuss massage. I believe acupuncture and laser therapy could help him, at least for the next 6-8 wks, as he resolves these issues. I expect him to be able to follow the homework protocol as written for the first 4 weeks after pain management and then we will discuss the program for weeks 5-8. After that, it is up to you, should he be improved and doing well, as to whether or not you would like further, more dynamic, homework.
Thanks again! Blessings- Deborah
AND, here is the owner’s follow-up report I received via email just a bit ago:
Hi Deborah, I was about to send you a quick text, when I saw this email (one I, Deborah, wrote asking how Dxxx was doing). Yes, Dxxx started antibiotics on Friday, and wow, what a difference. I saw almost immediately the change. Yesterday, almost all his walking was done with his leg down. I can really tell a difference. Thank you so much for getting us on the right path. I look forward to seeing you Tuesday.
He continued to improve and over about 3 months time he was equally muscular in both hind and had lost the extra fat he was carrying.
*** I have very many stories like this one, and I just now had time to share this one. 🙂 Hope it helps-