Yorkie Infection Pain After Knee Surgery – Issues in Rehab

Yorkie Infection Pain After Surgery –

This post actually applies to any pet after surgery and not just to Yorkie infection pain after surgery.

In a perfect world…

I would have already published a good-sized booklet about  common rehab problems I encounter and the solutions we work towards, for everyone’s knowledge, about what helped and what didn’t.

I haven’t done that yet, as of this writing.

Below is a bit of info about one case involving a Yorkie (Yorkshire Terrier) that had concurrent (at the same time) bilateral (both sides, in this case, both knees) torn knee ligament surgery and luxating patella surgery.

infection pain after knee surgery
Not the Yorkie knee, but a knee that is possibly infected.

Two Surgical Fixes on Each Knee?

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”.

On the other hand, neither of these surgeries absolutely has to be performed on a Yorkie, much less one that is receiving a solid, exercise-science-based rehab plan. We have lots of complete functional remedies in advanced exercise science. This surgery is not life-saving, while the expense and trauma are usually unnecessary for anyone willing to follow strict yet progressive and helpful recovery methods.

Regardless, two surgeries on each knee done at the same time is a huge recovery commitment. Whether you have one knee surgery done at a time or more, here is my “just got home” recovery advice and first four weeks recovery booklet. At least in this case I had the “good” knee to compare to the “bad” one.

Some Case Details –

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 control for 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.

Whose Fault?

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.

RehabDeb July, 2019

What Would You Do For MPL’s? (Medial Patella Luxation)

Hi, Deborah-

Dr. D at our clinic is referring a 1.5 yo M 31# mixed breed with bilateral medial patella luxation to you. How should we proceed?

Thank you-

 

Hi!

Glad you contacted me, and I will tell you that I start out MPL’s here on my website, if they will (and, as my website says 53.7 times, I’m editing and revising and changing a lot of content appearance):

Luxating Patellas

and this is one of the many pages I have yet to fix all the links on, add photos to, revise content, etc…
but it’s still relevant, so check it out if you’re interested.

The books on the page noted above are titled about CCR, but I cover how the books are relevant to MPL on this page:

Pet Injury

I have a lot on my website to help pet parents and clinicians and others work with their pets on their own in the home (or at the clinic).
I have a lot of words explaining that ^^ on my site, so I won’t fill up this email with more 🙂

Let me know if you have additional questions!
Thanks!
Deborah

Homework After Surgery or Instead of Surgery for Luxating Patellas (Loose Kneecaps)

First and foremost:  pay attention to the discharge instructions your veterinarian has given you if your pet just had surgery or has received instruction regarding an injury.  Please pay special attention to the part about no running, jumping, or playing. 

If your veterinarian did not say so, please note there should not be any flying over couches, galloping stairs, jumping into or out of cars and trucks,  jumping onto couches or your bed, jumping off of couches or beds, twisting very fast in tight circles, sliding on ice, or freedom in and out of doggie doors.  No owner jumping out from behind things to scare the dog into running crazy funny around the house like you sometimes like to do.   No running really means no running to the door when the doorbell rings, no running away from Halloween costumes, no running from one end of the house to the kitchen every time the fridge or a plastic bag is opened, no running to you when you yell to ask the dog if it wants to go outside, and no running inside after the ball, which is very similar to no running outside after the ball.  No, no swimming until at least 8 weeks after surgery and no lameness is present.

For further instructions, please see the additional links on this page about steps to follow after surgery.

and please see my related books (on Amazon.com. If these links don’t work for you, please search the titles, because I’ve made them available in all the countries Amazon has available…it just may be a different link for you than the one I posted here).

The first four weeks of information are the same for non-surgical and surgical treatment of luxating patellas, as they are for my rehab homework for torn knee ligament. Soon I will have a specific title available that deals with more specifics of luxating patellas.

Guidelines for Home Rehabilitation of Your Dog: Instead of Surgery for Torn Knee Ligament: The First Four Weeks, Basic Edition (Volume 1)

 

Guidelines for Home Rehabilitation of Your Dog: After Surgery for Torn Knee Ligament: The First Four Weeks, Basic Edition

Many cases of luxating patellas do not actually require surgery for correction; your veterinarian and I are able to work together in most cases to devise a plan that immediately reduces pain using medical pain control and gradually reduces pain while increasing thigh muscle & strength with rehabilitation protocol. There are many adjunctive therapies that are also helpful at this time, and they are discussed further in the book noted above. Also, please follow this link https://rehabdeb.com/pet-massage/ for some info on massage.

In some cases the patella ceases to luxate (flip off groove) when greater thigh muscle is created through strengthening exercises.  In some cases the increased exercise and specific exercise protocol for individual animals does not completely eliminate luxation, however in those rehab cases, luxation is often reduced and pain is either eliminated or greatly reduced.  These exercises are designed on a case-by-case basis and may include general walking, hill walking, sand walking, sand pile climbing, stairs, and a variety of other exercise physiology-based activities.

For animals with grades 1 and 2 luxation, rehabilitation protocol has worked successfully to reduce pain and/or luxation as well.  Grade 3 luxations are often similarly aided, however depending on the size and lifestyle of the animal or the severity of lameness, your vet may yet recommend surgery.  Grade 4 luxations almost always require surgery to hopefully improve quality of life, especially as your pet ages, and post-op rehab protocol should be advised (a notation of which follows this outline).

Rehabilitation should continue for at least six to eight weeks. Often owners relax around week 4, especially if things seem to be going very well.  If a rehab consult is not possible for an owner at week 5, then restrictions and exercises as per week 4 should be continued until an evaluation is made and new exercises are given or for the duration of the post-op restriction period suggested by your veterinarian.

copyright 2007, Deborah Carroll