Week 6 Rehab Instructions: Half Way Point & Power of ETA

47 Comments

1. At this point I would switch over to the maintenance. Very sorry for the long delay :)

2. Thanks so much Ted. I love that fact that we add value to people like yourself and help improve the life of your dog. I would love to know if the therapist said it was ok to follow our videos? Sounds like you are a great dog dad and all is going to be well, just make sure that you focus on long term joint health moving forward.

3. Our dog is now 8 weeks post op (TTA). While she goes to therapy twice weekly and I have been religious in her daily exercise and routines I want you to know how helpful your site – especially the videos- has been. The therapist just says do this or that but your site really gives me the dimension I need to understand how to apply this or that! Thanks. BTW she is doing well and I will see how well via her x-ray tomorrow.It is pretty obvious that she needs to build muscle on the treated leg.

4. My 8 year old husky had ACL surgery on June 3. I didn’t start her on GlycanAid HA- until June 18. She is on the 4th week of the loading dose. Since I didn’t start her immediately on GlycanAid HA factor, should I continue with loading dose, or switch her to maintenance?
   GlycanAid HA factor is fantastic! I have seen first hand how it is helping my husky. Thank you.
   Debbie Schoen

5. Kelsy in these situations with my patients I really want to know whether or not pain is a part of the equation that is resulting in a slower recovery. Therefore, in my patients will will put them back to a full pain medication protocol (ie. NSAIDS and tramadol) and have the owner observe whether or not there is improvement with this reintroduction. If there is marked improvement then I continue on with the pain medications for another 2-3 week or so and then slowly back off. That said the supplement that you are using is critical. Make sure it is the best.

6. My dog Trout is in week 6 of her recovery. She is putting weight on her surgery leg fairly regularly, but I have not seen much improvement across the last 3 weeks. We follow your recommended exercises and feed a supplement, but I’m worried her recovery has plateaued. In the evening, she’s normally back to lifting the leg and prefers not to use it. How do I know that we’re not ‘behind’ or that we’ve allowed her to hurt herself somewhere along the way?

7. Terri, this in unfortunate but not totally uncommon. I agree that muscle development is really important but you are right thinking with the ideal surgery the patella should be in place. There are several surgery options for the repair of an MPL and it all depends on the dogs conformation and the surgeons preference. There is the tibial tuberosity transposition and then the lateral stabilization with patellar groove deepening. Even with my clients I always utilize and encourage them to get a second opinion specifically with a boarded veterinary orthopedic surgeon. It never hurts thats for sure. I hope all goes well. Dr.J

8. My dog is 3 months post op TPLO, but only 2 weeks post op on her other leg where she needed MPL. I took her for her 2 weeks post op check and her knee is still popping out. I find this very discouraging and was told it was because her muscles need to be strengthen? That makes no sense to me. I don’t feel her knee cap should still be popping out right after surgery. I’d like to hear your opinion and if I should take her for a second opinion. Very discouraging.

9. Alexandra this is totally normal and I would say is a bit of a mind thing vs. speed and motivation thing. The thing to focus on is those slow controlled leash walking and making sure that you are moving slow enough that she is placing the maximum amount of pressure on that leg she can tolerate. Once you speed her up she will quickly adjust and compensate. At this point don’t focus on the in-house use of the leg. As always make sure you are providing the right pain medications and natural joint health support that she needs for optimal recovery.

10. Dear Dr. StClair,
    My dog is 5 weeks post TPLO surgery. She is using the injured leg consistently outside during her walks but at home she is almost always hopping keeping her surgical leg up. Why is there such a difference between how she walks at home vs outside? I put carpets in the floor but didn’t help. Any explanation/suggestions?

    Thanks a lot.

11. Victoria, I am a bit behind here in responses and I apologize. The holidays set me back a bit. First off set-backs happen all the time and you did exactly what you were supposed to do. Restart medications, strict rest, then reevaluate. You evaluation was perfect where you identified that she looked like back at week 3 so that is exactly were you start again. It is about the end result of 100% success and since you are committed to the long haul..you get it. As for your dogs looking back at it hip like there is a problem..I would say no that is not normal but in the early stages of recovery it can happen. Dogs will also begin licking at that problem area to pacify it. If this continues I would definitely have it checked out and maybe have an X-ray taken. As for the curb walking you really can do this utilizing any obstacle, even a bunch of sticks or small logs that the dog has to step over so go ahead and be creative…just be careful.

12. During week four my dog had a set back- holding leg up and really gimpy so I quit with the exercises and put her back on Prevacox and Tramadol. So we are now a week or more behind schedule. She seems to be using her leg now and is bAck looking like she did at the three week junction. Since she has done nothing but walking to potty, where should I restart her exercises? Also, is it normal for a dog to jerk around and look towards its hip as if something has bitten them? I live in the country, so we have no curbs to work on unless I drive then miles into town to do it. Is there any other exercise I could substitute? Thanks so much! Vicky

13. Lynetter, My suggestion in these situations is to go back and just read the weekly instructions and find the week (in the first 6 weeks) that you think she fits into and start there. Remember these are only broad guidelines and full recovery can take a full 6 months…the key is to achieve a conservative and safe recovery first and foremost. If you are slightly behind it is not a big deal as long as he is improving slowly on a daily basis.

14. Dear Dr. J,
    My dog, Kona, is starting his 6th week since his surgery. We have not been able to excercise his as much as we’d like to up until now. Should I delay his week 6 rehab instructions?

15. Brenda swimming itself is not the problem at 6 weeks post-op. The problem is getting into and out of the water. If you can do this really really really safe with no stress or struggling then yes swimming is ok in my book.

16. My almost 9 year old Flat Coat had a TPLO & meniscectomy almost 6 weeks ago. She is doing well. She will stutter step every so often, but being her second TPLO (the other 1.5 years ago) this one she seems to be recovering quicker. Her other knee also stabilized her patella, but this one the surgeon didn’t need to, her patella seemed more stable. I have a dock diving pool, with a ramp as part of my business here on my property. Is it too soon for any kind of swimming. I would likely put a life jacket on her to take any excess pressure off.

17. Judi I would not worry about the curb walking at all. If you are taking your dog on uneven ground walks you are doing great. Just continue to be conservative in the recovery because you are still only at 5 weeks and focus on the other exercises, especially the hill walking. Keep up the good work.

18. My 78 lb. Lab is walking on all fours and is in week 5 and walking up and down slopes, hills, wood paths & dirt roads fine. But, I live in rural Vermont and the curbs are 6 miles away. Is there something else I can do in lieu of this?
    Judi
    Thank you for the excellent weekly instructions; much appreciated.

19. Cheryl, often these are not hematomas but serums. You can either have them drained by your veterinarian or you ice them multiple times a day and massage the fluid anterior (i.e.. Back to the bodies core). You can also ice this area several times a day for 3-5 days.

20. Logan had TTA 6 weeks ago and deloveped a heamatoma on the upper knee. What can I do for this?

21. Barbara unfortunately I would need more information from you. What surgery did she have? If she generally a mello dog or easily excitable? What ever you can give me would help.

22. I have had my dog in cage 3 x 5 cage for 6 weeks. it gives Bella room to stand and turn around. She is doing very well. Do I still need to keep her in the cage?

23. That is great news denise…just not sure how to explain the sleeping more

24. My Springer is 6weeks post op, TPLO ,walks very well putting all four legs down 99% of the time.he seems a happy boy therefore no meds?However he’s sleeping much more than pre op.Hes 7years old by the way.Thank you for the very useful info,it’s wonderful to refer to.Denise.

25. Jana no quite sure why that is happening. My suggestion would be to go to You Tube and search for topdoghealth. All the videos can be found there as well.

26. Love all the rehab instruction but can’t get your videos to play. Have tried on my computer, iPad and phone but nothing happens. Any suggestions?
    Thanks,
    Jana
    PS my 6 year old Pitbull is post op week 5 FHO surgery

27. Eileen, Thanks for the message. Sorry for the delay I was traveling and just now trying to catch up. I apologize. I love the message because I really frustrates and also amazes me when I hear these stories. Every surgeon has their own “Way”. Some are conservative and other are very aggressive with post-op therapy, yet there is no standard. That said there seems to be much more standardization on the human side and hands down therapy is an important part of the equation. I NEVER go against what a veterinary surgeon say but at the end of the day the pet owner has the end say and with information available online from true experts you would agree that our information and guidelines are in no way “RADICAL” …in fact they are conservative and realistic. The end of the day…the only thing we both want is your dog to get better and have a good quality of life and after providing this information to well over 40,000 pet owners over the years the feed back has always been positive. Good luck and keep up the good work and if you need to by all means use my name and I will take the heat.

    All the best, Dr.J

28. Hi Dr J–
    We’re 5-6weeks post TPLO….just got yelled at by my vet: let me explain. After finding out my dog needed A TPLO I went online to find out what it is; like I do w/anything new. Your site came up, UC davis, Cornell, Ohio State and a host of others. Long story short–my surgeion believes the dog should still be crated at this point, only going out on leash for potty breaks. OK, I’m not a surgeon but I am an athlete and also have horses….I apparently shouldn’t be following your advice (no , havent’ mentioned your name). HOWEVER, I’m here to tell you we did our first underwater treadmill today: 5min x2 with a 1 min break in betwn. She’d have never made it if we hadn’t started walking…..I’m all for common sense and if I sense what we’re doing is too much I back off. I think your site and info is WONDERFUL for the layman….keep it up. will keep you posted. Seriously–WHY do they think her PROM was so good ?! hummmmmmm

29. Parisa, as you would expect all dogs heal and progress at different rates just like with people. There are so many variables in play. For 6 weeks out with two major surgeries under her belt…the fact that she is using the leg is #1 the most important thing. If she is no on anti-inflammatories or pain meds still you may want to discuss trying putting her back on them for say a week and see if there is a noticeable difference. As for the leg lifting while trotting this is totally normal and expected. If she is not using the leg 100% at a walk then there is no way she will use it well at a trot. You have to master short controlled leash walking first before you can expect to achieve success when the speed is increased. I always use the analogy of a baby. There is no baby on earth that just starts to learn walking and then gracefully runs…they have to fast walking first. Good luck.

30. Hi Dr. St. Clair,
    Lucy, my 80lb german shepard mix dog (8 years old) had TPLO surgery and a dislocated knee cap 6 weeks ago. She doesn’t keep her leg up anymore (she intermitently does when she trots), but she still limps quite a bit. Should she still be limping at this point? And is it ok that she puts her leg up every now and then when she trots? Thank you!

31. Heidi my suggestion would be to stay away for that snow…It is great that she is doing well 9 weeks out but walking or running through the snow requires a whole different movement and exertion than walking on flat ground. I would stick to the streets and walkways. I would also suggest if you can to find a local rehab facility in your area that has an underwater treadmill and a professional that can guide you. The underwater treadmill can do AMAZING things and provide great exercise and structure to that exercise. :) Hope this helps but avoid the snow unless you are skiing :)

32. Lucy is an 18 month old lab mix and is is 9 weeks postop with a Tightrope knee surgery. She injured her knee at 5 months and endured 10 months of conservative management. I’m getting to see her do all kinds of firsts, but I’m still very careful with her.
    We’re in NW IL and while I appreciate your video’s on rehab, we have a foot of snow on the ground! I still have her on a short leash. I take her swimming at least 1x a week at an indoor pool. Do you have other suggestions for indoor rehab..or outdoor rehab in the snow? She loves being outside and playing in the snow. Can you give me some thoughts on what is good about the snow..what to be careful with in the snow?
    Thanks!

33. Francess here is the link to week 4: https://topdoghealth.com/rehabcenter/week4/

34. Of course there is no way for me to give you substantial advice because I have no way of evaluating him but I would say this. If it was a one time occurrence and he shows no other signs for worsening or greater limping then I would not worry about it and continue to more forward in his recovery. Just be conservative. Time heals almost everything and having the right therapy and exercise plan speeds that process…You are so early in the recovery stage that I would just take one day at a time.

35. I still cannot find the instructions for week 4 and noticed others have had the same problem

    Thank you!!

36. I’ll try to be brief but informative. My 6yr3mo old beagle blew out his left knee on 11-30-13 whle waiting for TPLO surgery on 12-5-13 for his right knee. So the doctor performed TPLO on the left knee since there would be less long term damage, such as arthritis.
    TPLO was just performed on his right knee on 1-8-14. When we took him in the day before, his left knee had some swelling in it which is now gone due to the Meds.
    He does not seem to have pain in his left leg, but he stretched the other night and I heard a loud pop as my knee or elbow will do once in a while. I called the hospital and talked to the nurse and she seems to feel that it is nothing to worry about.
    The meniscus in his left leg was fine at time of surgery. The one in his right knee had complex tears and I could hear clicking very frequently before the surgery. I can’t say if I have heard anything from his left leg but the pop. I am with him almost all the time and even sleep on the floor with him in case he needs anything.
    He has been on a joint sup (tho not yours) since November that has 500 gluc, 100 chon,10 MSM,1 HA. I have recently put him on one that has 500 gluc,200 chon, 200 MSM,200 GLM, 13 omega 3,170 omega 6, and 10 HA.
    I know you don’t have a crystal ball, but I trust your opinion as much as the nurse’s. Should I be concerned about the pop since he shows no signs of anything wrong other than the swelling before this last surgery?
    Thanks in advance for any advice. He is a very special boy and has been through so much.

37. Jacqueline, my guess is that she is not on any pain medications right now. If this is true then you need to go back to your veterinarian and get her back on an NSAID and tramadol at minimum. If she is currently on pain meds then you really should have her x-rayed to make sure she does not have a bone spur that is causing her discomfort. You are still only at 6 weeks so have you much time ahead. Just keep focusing on the therapy that we lay out for you in the FHO guide.

38. Molly is 6 weeks post open but is still only using her leg about 50% of the time is this normal I worry I won’t every see her run and play like she did before her FHO surgery

39. Lina the acute pain from the additional fracture should start to resolve over this 4 week period of time. You just need to be very very very careful and conservative with this activity level. He should ALWAYS be on leash! Just please be very careful.

40. Buck is 8 weeks post tplo and started to limp more and had his follow up X-ray. Plate is healing well but the dr found a small undisplaced fracture at the site of the superior pin. They had to put and extra pin in due to buck being a “big” dog. 116 pound very athletic lab. Dr said fracture is why he is limping more. Doctor was not to concerned and said it should heal fine but just extend his recovery. how long till I see improvement. He wants another X-ray in 1 month your thoughts are always appreciated

41. Valerie…”little” set-backs happen all the time. A little tweak here, a little tweak there. My recommendation is to always pull way back on exercise, give anti-inflammatories and pain meds, rest, ice and then reevaluate in 3-5 days. Of course it NEVER hurts to have them looked at by your veterinarian but the fact that she is a little better after 1 day that is encouraging.

42. Karen the question is did your surgeon do a meniscus release when they did the surgery? If the clicking is not related to any lameness that I would say you should be fine to do the curb walking. Of course it is best to check with your surgeon just to make sure that they dont have any problems with that. Also just make sure you have her on a good joint supplement to promote optimal health of the joint.

43. Lana is just at 6 weeks. She is happy and off all meds other than supplements. However she turned up limping yesterday. I rested her and she is a bit better today but not fully putting weight on. Normal? Do i rush her in for an xray?

44. My Golden, Shelby, still has a “clicking” noise at the surgical site, @ her knee. Do you think it would be safe for her to start going up and down the curbs? The “clicking” noise is less now, but, it is still there. Thanks. karen

45. In response to the loose stool concern….MSM is known for causing loosening of the stool in humans…perhaps in dogs as well? Eventually the human adjusts to it….it’s worth the wait because its a great anti inflammatory! As a runner I rely on it.
    Btw…my girl Sage (week 7 cruciate) is doing beautifully on the supplement and is on her way back to 100% thanks to your program.

46. Linda with any change in diet loose stools can happen. Also glucosamine has been reported in some dogs to have this effect.What you can do is stop the supplement for a period of time, give it 5 days and see if the stool gets firmer. If you then restart the supplement and the stool is loose again than you know this is the culprit. If this happens tell us.

47. shouldmydoghaveloosestooltakingglycanaid?