Week 8 Rehab Instructions: Let the Hills Begin!

51 Comments

1. You are correct :)

2. Karen I would follow along with the advice of your surgeon because they are going to know best for your dog since they have a one-on-one relationship with them. That said I think it is critical that you focus on the long term result and that being conservative is never a bad thing. With the TPLO you have to remember that the tibial bone was cut entirely through, therefore essentially this is a broken bone. You will get callus formation in 6-8 weeks and then remodeling. No matter what you are still talking about a full 6 months for recovery. If he is tolerating the 15 minute walks with no problem them naturally you can start to increase the time and intensity but just we careful. Hope this helps, Dr.J

3. My 2 year old Golden Retriever had TPLO surgery August 26th. We are starting week 7 and he is doing incredibly well. He is putting full weight on that leg (when he hikes to pee) He seems to have plenty of energy but we keep him restrained on walks. My question is how long of walks should he be able to do? Right now we are walking about 15 minutes 4 times a day. I don’t think it is enough for him. Please let me know. ALSO, the vet told us prior to the surgery that our dog had torn both knees and required surgery on both. He did the TPLO on the worst first. Now I need to schedule the second surgery. Is it too soon to do Nov 11?

4. What is PSOM & PROM.
   I’m assuming that PROM is passive range of motion & PSOM is passive ?
   of motion?

5. Courtney, in 12 years of doing this I personally have never heard of this happening with a Tibial Tuberosity Transposition, yet I am sure it is possible. These pins are foreign objects to the body and it may be that the body is pushing them out. At this point, 12 weeks post-op, you should have great callus formation and boney remodeling so the knee should be stable. If your surgeon recommends removing the pins then I would listen to them. The surgery to remove them should be no big deal with only minor incisions and since they are irritating him, I would do this sooner than later. Hope this helps but no doubt your surgeon would be the best to judge the optimal treatment plan for Hank. BTW love the name…I have a Frank and Marty. All the best, Dr.J

6. Great question Lil, The reality is that PROM is really important for dogs who are non-weight bearing on their surgery leg so that we continue to remind that joints that they are dynamic structures ie. in contact change. We want to keep the joint fluid viscous and the joint capsule soft. In your case, if your dog is doing well and bearing weight on the limb on a regular basis, then it would be ok for you to stop doing the PROM. Yet if your dog tolerates this therapy and you doing mind doing it then by all means you can continue to do this along with your massage and it will not hurt him at all. Hope this answers your question. Dr.J

7. My dog Hank is 12 weeks post TTT surgery for his medially luxated patella. We have been following your site religiously. Thank you!!! Question for you… Hank’s surgeon thinks his implants are starting to migrate (are loose) within his bone and would like to remove the pins and wire. Do you have any advice on this or experience with this? I’m not sure what to do. The more Hank’s activity increases, the more he is bothered by his knee. He abruptly stops, sits and licks the incision area. Thanks for any advice.

8. My dog is one week post FHO surgery and is weight bearing on his short slow walks. On your UTube video you mention PSOM can be discontinued if the dog is bearing full weight on the leg, but your download guide doesn’t say that and PSOM is listed as a continous modality. Please explain when it is ok to stop PSOM.

9. Angela, we have a video on the topdog website…www.topdoghealth.com/rehabcenter. The video on massage is very basic but covers what is most important for this. That said there are a ton of other videos when you search youtube.com for videos on massage.

10. Was wondering the proper way to massage the leg and any pointers? Thanks so much

11. Stephanie I am getting to you a bit late, sorry for that. My youngest child thought it would be funny to pour a glass of water on my computer which was great :). All good now. I assume by now that you contacted your surgeon and everything is getting better but just my thoughts. When I have set-backs like this, which are totally normal and common, I generally immediately put my patients back on anti-inflammatories and strict rest for 3-5 days. If the dog is not improving then I will see if immediately for X-rays. That said if the joint is hot and painful then I would want to see it sooner. Hope you are both well. All the best, Dr.J

12. Angela I would say that this is normal. Just a few thoughts. First if he can tolerate the 1 mile mark then this is your baseline which you work off of. Second if you have not already I would get him started on a really good quality joint supplement like our GlycanAid HA. This can make a huge difference at encouraging optimal joint health. Third, keep your eye on the 6 month mark which I deem it usually takes for FULL recovery. Overall sounds like you are doing well. All the best, Dr.J

13. Hi,
    I’ve been doing my best to follow your rehab instructions, due to the weather we have been doing our exercises inside and not doing curb walks or hills. That being said my dog is a 15 year old bichon and this is his second tplo: he had his other leg done 2 years ago. We had our 6 week vet visit and she was very pleased with his results and progress.
    He’s been bearing weight equally on both legs, but today when he woke up he was sitting and lifting his operated leg in his crate (he always sleeps in his crate). We walked a little on a short leash and he was ok. But I’m noticing he’s not totally bearing weight and at times has a funny walk, possibly a slight limp. I’m worried he’s had a setback. What do I do???

14. we are at the 7 week mark today. He is doing well, but limps much more towards the end of the day. Normal? Also, how far should I be walking him? Ive been coin about 1 mile a day and he seems ok, but then, as I said, later in the day he is limping.

15. Herb of course I would first recommend that you have the surgeon who did the surgery evaluate your dog. That said I have seen these many many many times and this is a functional change of compensation where your dog is adjusting the position of the leg to reduce the total weight bearing. Over time this resolves with the progression of total healing, but if you are concerned it never hurts to have it checked out.

16. Todd, in these situation where is there is a perceived set-back my rule of thumb is to pull way back, go directly back on to anti-inflammatories for 3 days with strict rest and then reevaluate. In the over 10 years of working with these patients I would say that set-backs or some sort are fairly common. Sometime they are bigger deals but in general most of the time, rest and anti-inflammatories are enough to get things straightened out again. If after this 3 days rest period the dog has not returned to the previous level of function then I would definitely call your surgeon or veterinarian for an evaluation. Hope this helps. Dr.J

17. Our Golden had TTA surgery 7 weeks ago. Is putting weight on the leg, little limp, not much. Doing various exercises. But leg is splayed outward somewhat, not tucked in in a normal fashion. Is this somewhat normal until she gains more muscle strength?

18. Dr. ST Clair. I am about 8 weeks in and my pup has been doing well with walking. Today however he had PT in the water and started putting his leg up. He has every now and then done this but today was more noticable wnd the PT stopped the session. I am worried that we had a set back. He has been walking on it since we have been home after the session but I did notice him limping. Just concered.

19. Ellen no doubt it takes time to work-up-to the full and good form sit. In the video on sit-to-stand I have posted in the topdog online rehab center I demonstrate the concept of the half-sit, where you don’t allow your dog to full sit. This is a great way of slowly working your way up. As always in addition to the exercises you really need to make sure you are providing the nutrients for optimal joint health and comfort using a high quality joint supplement like topdog’s GlycanAid HA, if you are not already. Patience and persistence are the key, and if you continue to work at it you will achieve the results. Best of luck and hope this helps. All the best, Dr.J

20. dr. james ruby & I are in week 8 following your protocol with sit stand exercizes, but still not getting the same square sit that you say we should work for. I may not be doing enuf sit stands. what else can we do for more flexibility in the joint.? is this something that will never quite be the same as the other knee? thanks for all the help. ellen & ruby

21. John though this may be normal for your dog at 8 weeks, I would say that for the average dog 8 weeks post TPLO they should be fully weight bearing on the leg. If you do not think that she is where she SHOULD be, I would setup and appointment with the surgeon to have her checked out. Also if you have not already I would strongly encourage you to get her started on our joint supplement GlycanAid HA as soon as you can. This natural joint supplement is packed with everything her joints need to promote optimal joint health. My feeling is that if they are only partially weight bearing then there is a reason for this and obviously the knee does not “feel” perfect ie. they still may be in some pain or discomfort. She may need to pain management for a long period of time and I would discuss this with the surgeon. Hope this helps. Dr.J

22. Dr St Clair,
    Molly, my 1 year old 60 lb German Shepherd had TPLO surgery 8 weeks-ago. She has been confined to short slow walks and walks well on her leg. However, she is still only partially bearing weight on the leg. Also, the knee that required surgery is slightly larger and I can see and I think feel the screws. I would like to know if this is normal 8 weeks after the surgery. Thank you

23. Wendy, I have not come across a natural way to deal with the warts in my last 11 yrs of practice. Either you leave them, surgical removal or cryo-remove them ie. freezing. If you find a better solution please tell me.

24. My dog is a Poodle cross bichon who has made a great recovery from FHO 3 months ago and I also followed some of your tips. Thanking you.
    My dog is 9 years old and is getting quite a lot of warts…Any tips on how to remove them naturally? PS I am based in Australia. Thanks for your help

25. Jessica that is a great question and one that I get frequently. From my perspective Dasuquin and GlycanAid (unlike most products on the market) are both great supplements because they both use very high quality raw ingredients. That said…they are actually very different in their formulation. The most important thing is how your dog responds to the supplement. We have tons and tons of people who have made the switch from Dasuquin to GlycanAid and seen considerable differences in their dogs and some that have seen no difference at all. They are all so unique. As for your dog with an FHO…supplements such as these are really going to focus on protecting the other joints of the body. We have many FHO dogs whose owners swear by the GlycanAid HA supplement by topdog. The best part of topdog is that we have a 100% guarantee. If you decide to try GlycanAid and don’t think it is the absolute best supplement for your dog, tell us and we will provide you with a full refund. We only want dogs who benefit from this awesome supplement to have it.
    Hope I answered your question and all the best, Dr.J

26. Jessica when if comes to pancreatitis BASIC food are the best way to go ie. boiled chicken, baked chicken with white rice. I would make sure to ask the same question to the doctor who is managing your dogs health.

27. You have answered so many of my questions about Cody I am thankful have another question is your joint supplement better than Dasaquin. Cody had bilateral FHO and I want him to have the best chance to get better and too be able to run and jump and play.

28. What are the right foods. I don’t want to cause any pancreatitis or intentional issues but he see so eat only if I add a little table food.

29. That is awesome.

30. Jessica progress in an extreme case like his is going to come slowly…but it is these little improvements and little small steps of moving forward that should bring you great joy. I have to say in the last 11 years of practicing medicine and preforming rehab it always amazes me how these dogs manage to recover and return to normal activity. I think it is awesome that you are going for therapy and this should over time be incredibly helpful in his attaining full recovery. So to answer your question …yes he can recover. I wish that I could see him and examine him myself to provide the best advice. Hopefully now that the antibiotics are completed his appetite returns. Just continue to spoil him with the right foods..

31. We are doing 1 to 11/2 block walks and he goes up little slopes. I throw the ball about a foot and make him get up and get it and bring it back about three or four times he likes that.

32. He is still not eating well, but a little better.. I think the amantadine is helping and the remeron . Today he went and looked out door. This s first time in months . I am not sure what else to do. Today is his last antibiotic dose. Still on all other meds. He still has lumps where surgery was. The right side is worst goes up and down. I hope infection is gone. Do you think he can still recover. My vet says yes. I don’t want him to be in pain all the time. He is going to therapy tonight and I will get him weighed. He eats a lot of yougurt and blueberries. I just want best for him. Today he seems little better but nowhere where he should be.

33. Jessica I feel horrible for you and I am so sorry that I am so late in responding to you. Unfortunately i was away on vacation with my kids and did absolutely nothing in terms of work. I am sorry. Before I get into responding to this which is now not relevant can you tell me how he is doing now and where you are at. Dr.J

34. My dog had a bilateral FHO surgery about 8 weeks age. He was doing pretty good followed everything you said and vet said. He ran away from my husband once when he was putting leash on not far and he stopped. Since then he has not done well he had to lumps on his hips full of fluid one is almost gone the other on the rt hip is still there. He had a bad infection there and is on strong antibiotic ,prendisone ,tramadol meds for stomach and as of last night he was put on amantadine to help with pain too. He was in hospital for 6 days about two weeks ago because of his set back. Besides him not getting around like everyone said he has lost 15 lbs. since 6/26 he has lost 2 more lbs and no one seems to be alarmed but me. He is on en can and dry if I can get him to eat a cup a day I am lucky. He does eat yogurt and blueberries. I am so worried. We had to have both legs done at once because neither one could have held him alone. He just turned 1 year old. I don’t know what to do. The vets he goes to are very good. He has been getting laser about 4 x week plus therapy. I don’t like these lumps but they don’t want to drain them because of infection. He is such a good dog. The breeder said I should tube feed him but I would not do that. Please give me any ideas you have. I have tried all kinds of food and I hand feed him. He doesn’t eat meat table food etc. I want him to get better and live.

35. Gary that is great news. Having the right plan and the right tools for health is the key. Glad we can be a part of your lives. All the best, Dr.J

36. I started my Lab mix Miranda on GlycanAid just before her surgery on her left knee (ccl tear). I also ordered your rehab guide and have been following the recommendations weekly. At her 6 week check-up, her surgeon said she was pleased and said Miranda was ahead of the curve. I will continue to follow your instructions and keep her on GlycanAid for life. Thanks for all you do.

37. Grace absolutely the treadmill is great…just make sure that you have control with a good harness or slip lead.

38. my german sheperd samson, is 8 weeks post TPLO surgery. He is confined to his crate during the day with a break at about 11am, when he gets to be walked on leash around the yard with a bathroom break as well. is it ok to do treadmill walks?

39. Peppercorn has always been skin-and-bones: she won’t eat if not hungry. Muscle mass, hard to tell because how the leg is bent changes everything. I mostly around her shoulders. She really wants to do the stairs, goes up 2flights in a row now, following my finger. But I’m still resticting downstairs.

40. Thanks Robin..I love the fact that your surgeon recommended us. Believe it is rare and most pet owners have to find us on their own…so my hats off to him/her for recommending our information. That being said..that is great that they are all feeling better. It is truly remarkable to me how shedding a few of those extra pounds can make such as dramatic difference. I have been telling people for years and years. Good job. In terms of body mass are you referring to muscle mass specifically or to overall weight? I apologize for my delay, I was away at a conference for the last week. I will await your response.

41. Thanks again for the very informative stuff: our vet surgeon was right about you.

    We started our 3 dogs on Glycanaid (we got the shipment on week 4 of Peppercorn’s luxating patella surgery). All dogs are friskier than they used to be: more puppy-playful like…. but we’ve also been giving them much more fish. In all cases, they’ve been loosing weight (in a very good way) so I’m sure this helps with attitude. Comments?

    Anyway, since her surgery, we’ve noticed Peppercorn lost lots of body mass (she just doesn’t eat if not hungry). Her vitality is fine, but I’m concerned with shoulders going downstairs (going up is fine, but different muscle groups). She is long-legged and very athletic. She does let us know when she is tired or sore, but she is very eager for more: good thing she respects my lead! Recommendations?

42. Hey Barbara, Sorry for the delay. Yes the plate in the very cold will itself get cold. Since it is put on the inside of the leg where there is minimal muscle and soft tissue covering it is not really insulated all that well. I have had reports from people who do say in the very cold there dog limps slightly. I would pose this question also to your surgeon just to get his opinion. As for the thickness any soft tissue swelling over time will resolve and yes you should be able to feel that plate. Just one more thing…if you feel like the plate causes discomfort for him in extreme cold you can always have the plate removed fairly easily after the bone is all heal. Lastly it is awesome that you have been giving him GlycanAid on a daily basis. This is an incredible joint health supplement that we built with only the best raw materials found here in the USA. We are very proud of it but more importantly we are grateful for how well it works in helping dogs joints be comfortable. All the best to you. Dr.J

43. Hello Dr. St.Clair,

    Again thank you so much for these weekly rehab instructions. They have been so helpful as well as reassuring.

    I have a 5 year old German Shorthaired Pointer who was very active daily up until his cruciate injury. He is athletic and we are looking to get him back to hunting because he loves it so. Luckily, we had an experienced surgeon who works on sporting and police dogs frequently.

    My question is two fold: Will the metal plate become uncomfortable for him hunting in cold (very cold) weather? and will his surgical leg remain thicker? The difference seems so noticeable. I don’t think it is swollen. I feel the plate and screws. Is that normal?

    He is doing well. Never off lead except in crate. Doing slow controlled walks, some hills and curbs, figure 8’s, etc., is on your joint supplement. Thank you for all you do.
    Sorry if lengthy.
    Barbara

44. :) Good luck Jeanne.

45. So sorry Dr. Sinclair,
    After sending the last inquiry I noticed that the question had already been answered and I will contact your staff for the week 8 instructions at: [email protected] Thank you for your time.

46. Charlene, I would just ask you to send an email to my staff at [email protected] and we will get those out to you. That is awesome that he is doing well and I will also look into the week 8 instructions. Thanks.

47. Thanks.
    Also, I haven’t received week 9 or 10. The last I received was week 8 and it wasn’t about stairs like the heading suggested.
    Please send me all recent instructions again.
    Our dog is doing great and I want to continue with the protocol!

    Thanks again,
    Charlene Dickinson

48. Charlene, I will definitely look into this and correct this for the future. Not sure why this is…I write everything but my team puts it all together and somewhere we missed a beat. We will get right on this.

49. Week 8 is labeled “stairs and beyond” but the article talks about hills, which has already been reviewed.
    My question is should there be information regarding stair work for week 8?

    Thanks

50. In your dogs case the best thing you can do is really two fold. If you were able to find a canine rehab facility in your area (At topdoghealth.com we have a USA directory of all rehab facilities) they would be able to focus on more general strengthening. Also a lot of these facilities have cold laser therapy which could prove very useful for him. Second would be to just be conservative and give him the time needed to recover. The fact that you are 8 weeks out and he is doing well, plus that he is 14 years old…it sounds to me like you are doing everything right. You just have to slowly increase the time and intensity or difficulty of his exercises. This is why I always strongly encourage people to keep a workout log for their dog. I know that you are looking for more specific advice but unfortunately I am not there to evaluate him and make specific recommendations. Best of luck.

51. My 14 year dog has a torn CCL and because of his heart disease and age we decided not to do surgery. It has been 8 weeks and he gets around pretty well but is still on tramadol for pain. I am afraid to do too much strengthening out of fear the other leg will be injured. What else can I do to strengthen just the injured right back leg. I appreciate hearing a reply from you.