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

Rehab for Pet Surgery – 3 Steps

 

Spaniel dog with plastic Elizabethan collar on her

Jicky the Spaniel in the E-Collar after FHO

A quick bit of info for you after your pet has had surgery.

I do work on lots of cats and a variety of other animals. If you want to know more about cat specifics now, please search for cat in the search box. I’m still working on developing the cat information pages.

For more specific info on a particular condition, please refer to the menus at the top of the page. If you do not see what you are looking for, please use the search box on any  page.

If the injury is a torn knee ligament, then please click here to read more info about that condition. After that, please go to the instructions on this page!

“My pet just had surgery…
…and now that I’ve gotten them home, I realize I’m not really sure what to do!!”

First and foremost:  pay attention to the discharge instructions your veterinarian has given you if your pet just had surgery or you have received instruction about an injury.  Please pay special attention to the part about no running, jumping, or playing. You and your pet will be doing good work for recovery if you exactly follow my booklet instructions.

If your veterinarian did not say so, please note there should not be any flying over couches, no galloping on stairs, no jumping into or out of cars and trucks,  no jumping onto couches or your bed, no jumping off of couches or beds, no twisting very fast in tight circles, no sliding on ice or slippery floors, and no 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, no kitty running from anything right after surgery, and no running inside after the ball, which is very similar to no running outside after the ball. No, no swimming until at least eight weeks after surgery and then only if no lameness is present at a slow walk.

DO work on the protocol below and the info contained in the instruction booklet.

1) Here are guidelines to follow for the first four weeks after surgery:

I currently have published one book to help your pet through four progressive weeks of recovery after any surgery.

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

This book is specifically addressing surgery after a torn knee ligament. Until I am able to publish the books I am working on that deal with soft tissue surgeries, hip issues, other knee issues, elbows, spinal issues and more, this book will be very helpful to you for the first four weeks of recovery if your dog has had one of these other surgeries.

This book has the information, restrictions and advice I would give after almost any surgery. If you follow the restrictions and the practical applications in the booklet, your pet should do well and recover progressively if there are no additional issues.  These restrictions will match a lot of what your vet surgeon gave you to follow after surgery.

My recommendations are based on decades of information we have in human sports medicine recovery. These methods matches up very well how your pet thinks and moves and behaves. This program matches up scientifically with how the body recovers.

These instructions incorporate steps  for functional recovery, so there is a LOT more structured and guided info in the book. The links to the book I made for this page will take you to Amazon. You may order the book from any bookstore using the ISBN.

I also have info elsewhere on this site about cats and surgery. Cats aren’t small dogs. Unless your cat will walk on a leash, which some do very well, I recommend looking at this page for now.

So, the following book will help you calmly and methodically approach recovery from your pet’s surgery. The book will guide you to establish a functional base of activity.  You have to build a good base to help recovery and to of avoid additional injury. This is only the base. I have more strengthening programs and other drills for you to do to return your pet to a rambunctious lifestyle.

A good recovery plan helps guard against future or further injury, especially in the opposite limb! I am very happy to report that people and dogs that follow both this and the non-surgical program for 12 weeks do not end up with the other knee ligament tearing. It’s all a matter of balancing the work. I design programs based on decades of experience with exercise physiology recovery principles.  My programs also help encourage people being connected to their pets!


Amazon

Books are also available on Barnes and Noble and you should be able to order them from any bookseller, especially if you use the ISBN.

Instructions for first four weeks for dogs after FHO (hip surgery where the ball of the femur is cut off):

Instructions for first four weeks after surgery for luxating patellas (flopping kneecaps):

Find a few more homework info pages by following the links in the menu at the top of the page.  Also use the search feature.

2) In addition to thoroughly reading any of that info (some of which now includes exercises available in book form), please watch > this video < twice, and begin to do this massage daily for a month:

Please watch the video to see my recommendations on method of use for massager unit AND so you will hopefully have success introducing the massager.

There are written instructions under the video on the linked page.
Here is what the massager looks like, and if you click on the picture, you may buy it on Amazon if you choose:

3) If your pet is still limping 5-7 days or more after surgery, please read this > pain post < all the way through!

There is more on the topic of pain within the books-

Check out other resources under the “Rehab Resources & Tools” link in the menu under the website title at the top or by clicking here

If you would like advanced or personalized exercises, then please 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.

Blessings-
Rehabdeb

(Original Post March 17, 2015. Updated July 29, 2019)

Physical Therapy as Effective as Surgery for Torn Meniscus and Arthritis of the Knee, (Human) Study Suggests

Just One of Many Studies Published on This Topic-

My programs for conservative (no surgery) treatment are clinically and anecdotally successful. So, this means that clients and veterinarians do the work and get good results.

Physical Therapy as Effective as Surgery for Torn Meniscus and Arthritis of the Knee, (Human) Study Suggests –

“Surgery may not always be the best first course of action.

A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. To reinforce that, this study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.” Mar. 21, 2013 — A New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and arthritis of the knee should encourage many health care providers to reconsider their practices in the management of this common injury, according to the American Physical Therapy Association (APTA).

The study, published March 19, showed no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone.

“This study demonstrates what physical therapists have long known,” explained APTA President Paul A. Rockar Jr, PT, DPT, MS. “Surgery may not always be the best first course of action. A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. This study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.”

According to lead physical therapist for the trial and American Physical Therapy Association (APTA) member Clare Safran-Norton, PT, PhD, OCS, “our findings suggest that a course of physical therapy in this patient population may be a good first choice since there were no group differences at 6 months and 12 months in this trial.

These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options.”

Researchers at 7 major universities and orthopedic surgery centers around the country studied 351 patients aged 45 years or older who had a meniscal tear and mild-to-moderate osteoarthritis of the knee. Patients were randomly assigned to groups who received either surgery and postoperative physical therapy or standardized physical therapy. Within 6-12 months, patients who had physical therapy alone showed similar improvement in functional status and pain as those who had undergone arthroscopic partial meniscectomy surgery. Furthermore, patients who were given standardized physical therapy — individualized treatment and a progressive home exercise program — had the option of “crossing over” to surgery if substantial improvements were not achieved. In this situation, thirty percent of patients crossed over to surgery during the first 6 months. At 12 months these patients reported similar outcomes as those who initially had surgery. Seventy percent of patients remained with standardized physical therapy.

According to an accompanying editorial in NEJM,”millions of people are being exposed to potential risks associated with a treatment [surgery] that may or may not offer specific benefit, and the costs are substantial.” Physical therapist and APTA member Mary Ann Wilmarth, PT, DPT, MS, OCS, MTC, Cert MDT, chief of physical therapy at Harvard University, said, “Physical therapists are experts in improving mobility and restoring motion. The individualized treatment approach is very important in the early phases of rehabilitation in order to achieve desired functional outcomes and avoid setbacks or complications.”

Story Source:

The above story is reprinted from materials provided by American Physical Therapy Association. Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:
Jeffrey N. Katz, Robert H. Brophy, Christine E. Chaisson, Leigh de Chaves, Brian J. Cole, Diane L. Dahm, Laurel A. Donnell-Fink, Ali Guermazi, Amanda K. Haas, Morgan H. Jones, Bruce A. Levy, Lisa A. Mandl, Scott D. Martin, Robert G. Marx, Anthony Miniaci, Matthew J. Matava, Joseph Palmisano, Emily K. Reinke, Brian E. Richardson, Benjamin N. Rome, Clare E. Safran-Norton, Debra J. Skoniecki, Daniel H. Solomon, Matthew V. Smith, Kurt P. Spindler, Michael J. Stuart, John Wright, Rick W. Wright, Elena Losina. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine, 2013; : 130318220107009 DOI:10.1056/NEJMoa1301408

Veterinarian Comments and Reviews

You may find more positive veterinarian comments and reviews around the web. Below are a couple I have copied from various web locations –

“We are so grateful for the expertise and compassion you provide the central/south Texas community!”
Mission Veterinary Specialists, San Antonio, TX

“Once again, thanks for engaging the veterinary industry and client owners with your work and experience. I enjoy your enthusiasm and passion for the area.”
DVM, ACVS (American College of Veterinary Surgeons), South Texas

“Thanks so much, Deborah! The book is impressive. Maybe you should leave a copy at (some shelters) since they put so many cruciate dogs on the euthanasia list…Great work and thank you!”
DVM, Austin, TX

“Read your book. Excellent job. Now at ACVS they are all for non surgical acl (rehab)…Good job!”
DVM, Austin, TX

book cover of my non-surgical recovery booklet

“Finished reading “instead of surgery” kindle booklet. Bueno! Great discussion on importance of pain control, in particular. ”
DVM, Austin, TX

“Hi Deborah! I read your book the night I got it. I really like it and have already recommended it to a client last week. I hope she bought it. I will write a review for amazon for you, too. I hope you are really successful in this. I know how hard you work!”
DVM, Kerrville, TX

“Once again, thanks for engaging the veterinary industry and client owners with your work and experience. I enjoy your enthusiasm and passion for the area.”
DVM, ACVS, South Texas

“Great plan outline! I’ve come to think that using the water treadmill is (overrated), and it’s nice to finally have a definitive plan to get clients on the road to recovery.
DVM, ACVS, Austin, TX

“Just wanted you to know I read and appreciated the CCL rehab book, I will likely keep a few in the clinic.”
DVM, Austin, TX

“Bought one of your books last week. Its great!”
Megan Kelly BVSc DIPVET CCRP Holistic Veterinary Surgeon, Cape Town, South Africa

Please see client reviews and testimonials by clicking on either ^^ word in bold color ^^ 🙂

Thanks! Rehabdeb

(Updated February 10, 2018)

Client Comments and Reviews

A few client comments and reviews from the web to get you started! See some individual testimonials here.

“Scientific”
“I’ve known Deborah Carroll for several years and she has worked with us rehabbing our 90lb Hound/Lab mix. I have always found her to be chock full of great scientific information in rehabbing your pet, and the booklet simplifies all that into simple to understand protocol and reasons to follow the protocol to help your dog. Short read but well worth it. I love it!”
D.B., Amazon Review

“Good Advice”
This book is very easy to read, with good advice for pet parents after a cruciate repair surgery. Compliance is a major cause for surgery failure. In a humorous way, the book gives good guidance on what NOT to do as well as a guideline for healing after surgery. I have recommended this book to several clients already and I wish I had the book last year after my dog, Rufus had his TPLO.
Thank you for the new resource,
Melanie Fox Vanicek, DVM
, Amazon Review

“Effective”
“Deborah Carroll provides effective exercises for physical therapy that are non-invasive and can be done at home with successful outcomes.

This is a great introduction book that explains the physical therapy instead of surgery route and what it means for you and your pet. These guidelines and exercises are a way of treating a torn ligament that works as long as you and your pet are ready to take the time to achieve results.

Surgery is not always inevitable and Deborah Carroll provides an alternative. My dog has followed these guidelines and has had great results. At the time of her injury she could not walk on her back leg (torn ACL, meniscus).

Through working with the support of our veterinarian for pain management, the physical therapy and suggested diet changes, she not only walks on all her legs again, she can go for long walks, climb hills and stairs and pull me down the sidewalk. We are proof that you can successfully rehab your pet at home without the trauma and recovery of surgery.”
Katie, Amazon Review

Easy Plan
“The book easily outlines a plan to rehabilitate your dog from a knee injury. I now feel like there is hope for his long term recovery. Thanks Deb!”
Amazon Review

“Completely Rehabilitate”
“Using the methods described in this book, we were able to completely rehabilitate our Labrador Retriever from a torn ACL without having surgery. Very thankful that this book was so easily accessible!”
H.P., Amazon Review

No Surgery
“I chose not to have my 9 year old Lab put through the stress of surgery on his torn CCL – knowing that he is already showing signs of the other leg being injured. After much research, I found Deborah’s website and read a lot of the blog posts where I learned of her book. I have been using the therapy in the book now for about a month and it is working well in conjunction with some holistic remedies and massage, Since the process of healing is really the same for both non-surgery and surgery dogs, this book will help either way! Easy to follow, but you do have to stick with it to see results.”
Amazon Review

“Expertise”
“I have worked in a variety of animal care fields – as a veterinary technician, pet sitter, and behavior consultant – since 1997, and have several mutual clients with the author. As such, I have seen first-hand what she can do for both her clients and patients. Her knowledge, skill, and bedside manner are impeccable, to the point that she has become the only person that I refer people to for small animal rehabilitation in the Austin area. I am so glad that she has written this book, so that people who live outside the Austin area can benefit from her expertise. I highly recommend it!”
Emily S., Amazon Review, From Beaks to Barks

“Practical”
“This was an easy to read and understand guidebook. There were lots of practical tips offered. Her program is something I can follow on a day to day basis. The author has obviously had lots of experience with dog rehabilitation and wants the best for our dogs.”
Lori L., Amazon Review

“Love”
“I love Deborah Carroll and her approaches to rehab/conditioning- we see her next week.”
Courtney K, Austin, TX Courtney’s Agility Page

 

Add your client comments and reviews in a comment, below, and I may add it to the site. If you have a pet-oriented business and you have used my program(s), please include the link to your business when you write your comment! Thanks!

Updated February 10, 2018