WEEK 1: REHAB INSTRUCTIONS: MINDSET & EXPECTATIONS

264 Comments

1. Terry I am very sorry to say I have no way of commenting on this. 3 weeks post TPLO, most dogs are walking on the leg full time, if not almost full time. If you want to expand on your thoughts I will make sure I check back in and comment. All the best, Dr.J

2. Just started week 3 after TPLO for a 1.6 year old bull mastiff. What stage should she be at?

3. The passive stretching exercises in no way should create enough tension to damage the ACL or any other soft tissue for that matter. If you can provide me with an update at this point. Dr.J

4. David my answer would be yes, you can use the harness to do the stairs. The key is on control and momentum. You just don’t want your dog moving FAST with no control because that is when injuries happen. I am sure you are going to be totally fine. Dr.J

5. Veronika, this is always a tough one for me. In some cases bilateral stabilization is the right choice and in others it can be a nightmare, it all depends on the dog. If you are uncertain or don’t feel totally comfortable with the advice of your surgeon it never hurts to get a second opinion. Some surgeons are more aggressive then others depending on their experience. This is a tough situation and I am so sorry that both of you are experiencing it. Dr.J

6. Cynthia, to answer your question it really all depends on degree of the cruciate tear. With the small dogs many of them can eventually be fine with conservative management, though even with these dogs surgical stabilization of the joint is optimal. I try to get everyone to adopt the mindset that FULL recovery, no matter what is going to take a full 6 months for sure. Not only should you be focus on the recovery or stabilization of the injured leg, but you also need to focus on protecting the other hind leg. It is estimated that 30-50% of dogs will go on to tear the opposite leg. That said, if you are pushing forward with conservative management then make sure you are doing everything in your power to support the leg. From my perspective I would start at week one and slowly move forward. Make sure that a really good joint supplement is a part of your optimal joint health plan. Hope this helps, Dr.J

7. I just started getting the rehab instruction for week 1, but my 7 pound chihuahua is on 3 weeks recovery from a torn ligament so do I start with week 1 or do I need week 3? I’m doing the conservative management she’s still not putting all the weight on the leg yet.how long does it usually take before they start using the leg again all the way?

8. Thank you for the 1st week instructions. I have not fully decided if we want to go through all this with our rescue puppy. Your information above reads: “Remember you are trying to protect the other hind leg from injury.” but we got the suggestion to do bilateral saving cost and for Grace to go through the process twice. What do you think of that with her not having much of muscle mass at all on neither leg? Br, Veronika

9. Dear Doctor, I love your site – it has been very reassuring and informative! I have also ordered a 180 day supply of GlycinAid and the RX harness.

   My 54-pound Irish terrier Wilson will have TTA surgery on Tuesday. They are keeping him for two nights, which seems overly cautious to me, but I will deal with it.

   Anyway, I live in a second-floor apartment, with 10 outdoor stairs leading to the ground. I can carry Wilson up and down the stairs, but it is a bit difficult for me and not comfortable for him. My question is, when I can start taking him up and down the stairs using the RX harness?

   Can he use the stairs walking only on his front legs, with me holding up the rear, or does he need some use of his rear legs as well?

   Finally, how long should I use the harness before he can take the stairs on his own?

   Thanks!

10. I have one other question about the therapy vet we are using. She has suggested our route be pre-surgery therapy not post therapy for her luxating patella. I am working at home with her following your instructions and her’s as well. She has a slight torn ligament in the are of her problem. How best can I ensure during the stretching exercise that I don not damage the torn ligament further?

11. Purchased the Support RX Body Support system and it’s an excellent product.

12. Janelle, of course since I don’t have a personal doctor/patient relationship with your dog I can not give specific advice….what I can tell you is that if I had a dog who was 6 weeks out and starting from scratch I would focus on starting at week 2-3. My reason for this is that being conservative is not a bad thing at all. We all know that FULL recovery takes 6 months whether you are a dog or a person. Therefore starting at week 2-3 and establishing a routine upon which you can build on is the key. The worst thing you could do is to do to much to soon.

13. Thank you for your invaluable advice. My 6yo boxer, Raidar had TPLO surgery on both knees. The right cruciate was badly torn of which was removed whilst the left was not as bad hence they left this one. Surgery was 6 weeks ago now but our 6week check up, whilst good in that Raidar is walking well, the surgeon said his bones were not a close as he would like hence advised to continue with the “no exercise at all”. As you can imagine, after 6 weeks of no exercise, my boxer is jumping out of his skin hence I turned to your website. My thought is that if I can exercise him a little he may not be jumping out of his skin as much i.e. less likely to do damage by jumping around with excitement anytime someone goes near the front door. So yesterday I started the short controlled 5min walks and the sitting (of which he does sit really well when applying your video technique – thanks)…….my question is – should I start at the Week 2 recommendations (as per your recommendations of others below) or can I skip ahead a few more weeks?

14. Carmen, I sent you over the week three, if you are just getting started late it is best to start around week two and then move on from there. There is no harm in being conservative. Just remember, and you will hear me say it over and over again, FULL recovery takes most dogs a full 6 months total. Make sure you use the videos and information in the online rehab center at https://www.topdoghealth.com/rehabcenter. All the best, Dr.J

15. Thank you for your incredible guidance! We began Week 3 yesterday. Is there a way to update the email guidance from Week 1 to Week 3? We sooooo appreciate your help!

16. Jean it never hurts to go back to the loading dose for a few weeks for a boost, if she tolerates it well. Please keep me informed of her progress. Dr.J

17. Marjon, The first thought that came to mind is that you really need to not be so scared of pain management drugs at this point. This is such a short term period in which he really needs the assistance of proper pain management. He should be given an anti-inflammatory daily or twice daily and also a pain medication like codeine or even better tramadol three times a day. In order for this surgery to be a success for him he needs to be pain free so that he will use the leg and slowly begin to rebuild and strengthen muscle. Please speak with your veterinarian about this. In my FHO patients I use aggressive pain management until they are using the surgery leg near 100% of the time, and then and only then do I start to back off the pain medications. This is vitally important, otherwise you will rob him of the opportunity to recover 100%.

18. Hi Dr. J, my dog just had her second surgery on the other knee. Her first surgery was in January, and after a few months her other knee started to bother her. It had been weak to begin with so I wasn’t too surprised. I’ll be following your rehab plan again, it helped a lot the first time around! Abby is still on the Glycanaid HA and I was wondering if her dose should be increased due to the recent surgery. She currently takes 2 pills a day. Thanks for all your help!

19. I have 3 pound yorkie that had fho last week. I was not ready for what my baby and endured in the last week. The doctors made it sound so easy. Anyways we were not prepared. He is an indoor dog. Extremely stubborn. She doesn’t let me touch her leg. She doesn’t want to walk until she wants to. Etc I have been icing the leg for three days every hour for ab 5 minutes. Trying to minimize antiinflammatory drugs since he is so tiny. He takes code in based drug instead. Please help me to help him heal better. We will be forever greayful. Also the joint supplement you offer what would be the safe dosage for him? Does it cause upset stomach? Is it best on full or empty stomach?
    Looking forward hearing from you. Best regards

20. Sheryl for the dogs whom are not surgical candidates what I have been telling people is to download the cruciate book from Topdoghealth and follow it exactly as if your dog had surgery starting at week 2. In these case I also STRONGLY encourage people to purchase our GlycanAid-HA supplement. Though we never hard sell anybody on our products..in your dogs case I would be a bit more pushy because I know it would help tremendously. Lastly I would make sure that I discussed with my doctor good comprehensive pain management and make sure that pain is not a part of his recovery equation. Hope this helps and good luck. Dr.J

21. Dear Dr. James
    My older dog (13 years) is not a candidate for surgery for his torn ACL what suggestions do you have for helping him heal without surgery what can I do for him

22. Nami, I always get such joy reading messages from pet owners like you, who are half way across the world. The internet is such an amazing vehicle to spread good and help others who we will never have the opportunity to meet face to face but we can help. My best word of advice Nami for you is to just make sure that you don’t cut the pain medications to short. In my practice I continue with full pain management protocol until the dog is fully weight bearing because I never want pain or any discomfort to inhibit the use of the leg. Just a thought. Thanks for reaching out and we are here if you need us.

    All the best, Dr.J

23. hello Dr. James! my 10 month lab Zach underwent an FHO earlier this week. prior to the surgery I was extremely scared about how we would go about with his rehab since here in India we hardly have any facilities for canine rehabilitation. that’s when I came across your website and it’s really good. we’ve been following your instructions and he seems to be doing fine. we are on day 5 post op and he’s toe touching and intermittently partial weight bearing during the slow leashed walks. thank you so much for the help! Hoping we can go thru the rehab phase more smoothly thanks to your help! :)
    Regards, Nami

24. Mike this is a tough call. You are only just out of surgery so it makes this evaluation slightly difficult. I would probably not focus on this at this point and focus on whether she is weight bearing on that leg and continuing to improve over time. Wish I could give you definitive answer so help ease your fear.

25. My wire haired griffon of 6 years just had the TPLO surgery on her right rear leg two days ago. I started the PROM exercises and notice when I move the repaired joint, there is a distinctive click. Is this normal and will it go away with time/continued therapy? Thank you.

26. Anna, in this situation I would absolutely follow the advice of your veterinarian and treat her as if she had surgery. This will give a conservative approach and allow time for healing. Since I have no way of examining her myself I can’t really give specific advice but from the sound of it your veterinarian is a realist and smart doctor. The only thing I would say is make sure you also incorporate a really good joint supplement into the mix. I recommend you take a close look at TopDog’s GlycanAid HA. It is available on our site or on amazon which ever works best for you. Good luck and be conservative to avoid further damage and interrupt healing.

27. Linda the key is going to be good pain management and conservative therapy. If you have access to a local canine rehab facility in your area I would strongly recommend that you seek out their expertise. Also if you have not already you may want to pick up one of TopDog’s SupportRx total body harness. These are extremely affordable and great for female dogs. In terms of your post-op instructions they would be the same along with apply some therapy to the right (ie. massage). Again best bet is find a local canine rehab specialist and if this is not available then just follow along with the guidelines we sent and the individual advice of your surgeon. Good luck and she will be fine, it is just going to take a little longer.

28. My dog just tore her ligament, not completely but about a 75% tear, however the vet thinks it may not be the ACL and instead be the rare one that only happens in 1% of cases, i think he said it was the PCL. Because she can walk normally and i do not have the funds to pay for it, we are trying to avoid getting the surgery, but the vet recommended following your rehabilitation guide anyways. Would you have any other suggestions or do you know anything about this type of tear? Do you suggest following the 12 week program for trying to rehabilitate without the surgery? Again she is walking completely normal with no limp or showing pain, stairs are the only thing she refuses to do and i carry her up. Thank you so much!

29. Hi, I have a 2 year Husky who ruptured her cruciate ligament in her right knee. We tried to keep her quite and calm as our vet said to give her a week to decide on the surgery or not. 4 days later she ruptured the left leg. Left was more unstable than right so they did a TPLO surgery on Tuesday. We fetch her tomorrow. Advice for week 1?? We have got her a leg brace from Orthdog her her right leg (ordered before she damaged the left) will this really help her? We need to get her strong as she will have other surgery in eight weeks.

30. Hey Natasha, I wish we had video so that I could see real time what you are experiencing. That said I am not sure about you question #2 but what I can tell you is this….That harness is always meant to be two hands on the leash…kind of thing. The reason for this is that you want to control the speed of the dogs front end while you are also supporting them in the hind end. As for question #2 and how much you lift his hind end…it is also about control and supporting them as much as they need. When if comes to stair I just hold the hind and and take a bit of the weigh off just to help them navigate. From the sound of it he is a big boy with a lot of strength and doing well at 3 weeks post-op…so every day and every week he is getting stronger and feeling better. You have your work cut out for you in the coming weeks…just do you best to slow him down. Hope this helps. Dr.J

31. Carol PROM is ideally started immediately provided that they are comfortable and will tolerate the exercise.

32. Shelley my rule of thumb with at home care is to do only what they tolerate. You really don’t want to push them. If it were in our facility I may have a tendency to push them more, but only because of our experience working with these patients. Don’t stress about it…once it seems that she is more comfortable then go ahead and do the exercises. Good luck. Dr.J

33. Elizabeth I think it would be a really good idea for you to get a support harness. Our SupportRx would be perfect for a female three legged dog because the hind end support is via a belly band. I am sure she is going to do great you just need to do your best to keep her moving slow and protected until you get some good primary bone healing. Good luck and we are here if you need us.

34. Hi. I purchased the harness and belly support. I am having difficulty with it in two ways: 1. my lab is almost 80 pounds, kind of long and wiggles no end so I find it hard to control his front end. 2. How much do I lift for stairs. Yes, there is no way around a few stairs to get out of the house and into the yard. He is on week three, looking good and feeling strong and he is pulling me down the stairs.

    Thank you.
    Natasha

35. My dog Cora will have her surgery on Monday morning (3/30/15). On what day do I start the PROM?

36. Hi! Our 11 year old shitzhu has tight rope ACL surgery Wednesday. She is on predinzone due to an auto immune issue and is taking tramodol and gabepentin. She seems to be taking these Meds fine with minimal side effect thank goodness!! My question is about Passive Range of Motion excercises. We’ve attempted very softly to do this but she appears to be in so much pain! It only has been 48 hours post surgery and we are terrified to hurt her…is this something that has to happen right away or can we wait a few more days to start this. She also gets quite annoyed with icing…we are doing this every 3 hours right now..when can we slow this down? We feel so heart broken she is going through all of this pain!

37. My dog is having the TPLO procedure done in early April. She is an amputee (left hind leg), surgery on right hind leg. Wondered what kind of help she will need since she won’t have another leg to help her get around, but also won’t have to worry about injuring other leg. Thanks.

38. Jeanette that is fine. This clear discharge is called serosanguinous fluid and it totally normal.

39. Paul I am sorry that I am catching you a bit late and I am hoping that by now you have seen improvement from where you were only 3 days post-op. All dogs are different post-op though with the TPLO most do have a tendency to use the surgery leg quicker than some of the other procedures. If at any point you are concerned or question how she is progressing, I would most definitely call the surgeon directly since they are the ones responsible and know she particular situation best. All the best, DR.J

40. Hi Susan, what beautiful dogs Bouvier’s are. If I understand you correctly while on walks she still has a noticeable limp and then when she stops he holds the leg up slightly. So I would say that yes this could be perceived as normal even at 8 weeks but with a TPLO at 8 weeks post-op I would expect any limping to be minimal. You best bet is to have a recheck evaluation with the surgeon just to make sure all is healing well. Second I would then just want to make sure that you have her on a good supportive joint health supplement that is packed with everything that joint and all others need for optimal health. As for the swimming 8 weeks post-op I don’t have a huge problem with that as long as the process of getting her into and out of that pool is very safe and avoids any struggling. I would rather see her in an underwater treadmill at a local canine rehab facility though. As for the off leash and slower paced running my answer would be no way. She is not ready for that. She first has to master or achieve a level of perfect gait walking and weight bearing before she could ever be ready for increased speed. Once she is walking perfectly without a limp, then you can start to test increasing her speed and definitely always on leash. Hope this helps and answers some of your concerns. All the best, Dr.J

41. What is the best way to clean our black lab’s sutures? There is just a little clear discharge. Our daughter has been wiping it with a dry paper towel since when he is taken outside to urinate or poop the lawn is wet.

42. 7 year old Beagle a little heavy, had TPLO mon. Pm this is we’d morning. Has not put weight on it except for potty. Also does NOT want me to move it. Will let me ice but that is all.
    3 legs it up and down 3 stairs for potty. How long before she should kinda sue it. Should I take her back in?
    Thx Paul

43. hi there. I just connected with your organization yesterday. My 2 3/4 year old, 116 lb. Bouvier had TPLO Jan. 12 so we are starting week 8 next week. the email I received today was for week 1. I don’t mind having a reminder for the exercise though. We are walking 30 minutes twice a day on a leash now. she is coping very well but has a limp and hold her paw about 3 inches off the ground when standing still – indoors and outdoors. is this normal? also wanted to know if I could start taking her to a heated indoor salt water pool for a swim with me a couple of times a week – for maybe a 15 minute swim? at what point can I have her off leash and doing a slower pace run – sometimes when walking she speeds up the pace on leash to a little jog for a few feet – thank you for your help

44. Shirley a good support harness will make all the difference for you and make recovery safer for her as well. I would recommend going with the SupportRx harness that we have. For short term use and for girls this is a great value. As for the sizing the 2XL is probably going to be the best fit, but your best bet is to give us a call at 888-504-2220 and speak with Martha. She has the sizing down perfectly and she can help you. As for how long I would say that at least for the first 4 weeks it will be very helpful yet I know many people that continue to use it throughout the entire 3 month recover process just to help their dog get in and out of the car and up stairs etc. Hope this helps and hope her recovery goes really well.

45. Dr. St. Clair my 4 year old Lab just had cruciate surgery 2 days ago, she weights 92 lbs and I am struggling trying to lift her in and outside down 2 sets of 2 stairs. What size harness would she need and how long is a harness required after surgery? Thanks

46. Laura this is a great question and really all to common. Unfortunately there is no easy pill solution. It is a bit of discipline training mixed with strategy and confinement. Don’t get me wrong there are many of people who have to utilize pharmaceutical management to keep their dogs slightly sedated because they simply can control their dogs excitement. The most common drug for that is acepromazine and you may want to discuss this with you veterinary surgeon. From there if you are home I often recommend people to tether their dog to themselves ie. attach the leash around your waist so that your dog is calm and with you and is unable to have explosive movements. If this is not viable then a crate or good confinement will allow them to have adequate rest for healing. It is all a matter of finding the best routine that works for you. I wish there was a simple answer to your issue but no doubt it can be very challenging.

47. Kona had a Left TPLO last January, and just had her Right last week. Very different reaction, although last year she had torn her meniscus as well. This time she is trying to be way, way to active. When I picked her up from surgery, she was jumping up and down from excitement, and when they put her in the car, first thing she did was jump in the front seat. HOW do you slow down a 5 1/2 year old Lab???

48. Chris thanks for the message and good luck with everything. As for GlycanAid being available in Europe it is. Either we can ship it directly to you, though we have to charge the shipping cost, or you can find it through zoomadog.co.uk. Best of luck with Miles recovery and if you need anything we are here to help you.
    All the best, Dr.J

49. Elizabeth, the reason for this is solely due to the strict importation regulations of customs in australia. Because GlycanAid uses USA source bovine chondrotin and there are animal protein palatants used it is not acceptable for import to australia. That said, it would not be impossible to get GlycanAid into the country we would just need one of the larger animal health distributors to help us navigate the process. Hope this answers your question.

50. Terri, it is totally normal to be able to feel the plate because there is not a lot of muscle cover this. Also the episode you described is ok, we really are focused on avoiding big situations where they are exploding/running. Don’t stress, as long as she is doing well and was ok after that episode you are fine. Just continue doing the great job that you are already doing. All the best. Dr.J

51. Thank you SO much for your site! IT is so helpful. Miles, my 7yr old Jack Russell Terrier is being operated on tomorrow (TPLO). Thanks to your site, I feel emotionally ready and have studied your manual, seen the videos etc.
    My question is regarding your Glycan Aid supplement. I live in Sweden. Is it available here? Thank you again!

52. How come your chondroitin tablets cannot be sent to Australia. I saw somewhere that they cannot be shipped here. Just interested to know

53. I am so happy you have this web site and are willing to help and answer questions. I received none of this info from my surgery or my local vet. My one year old is 2.5 weeks post op. I’ve kept her on short leash for her walks outside and we are up to 10 minutes now. The other day I catch her slowing jogging down the hall which scared me too death because I know running is not allow. She wasn’t racing, but I catch her immediately. I’m so sorry she messed something up. Any advice? She seems fine and looks to be putting her weight on her surgery leg. She has been off pain pills for a week and shows no signs of pain. I also can feel the plate, is this normal?

54. Lee great question and my answer would be to always not push the therapy if your dog seems uncomfortable. You optimal time to do such therapies would be 1-2 hours post pain medications but that said again if he does not want you to do it…don’t do it. They key is in the slow controlled leash walking. If he is putting the leg down and putting weight on it then the passive range of motion is not necessary because he is engaging that joint.

55. Vickie, yes that is totally normal and common. No doubt it can get to look pretty gruesome. I would say that this can last for a good week. The key is slow improvement and resolution of the bruising with no excessive swelling noted.

56. My dog had TPLO surgery on Tuesday. Today he is 5 days post-op. He would let me do the passive ROM the first two days. Now he is not willing. Incission looks great. Swelling is at a minimal. Things look good. Should I be concerned? Should I continue to try?

57. Our 22 month old pit bull had TPLO surgery 3 days ago and is doing really good but he has lot of brusing. It started appearing the day after surgery in a couple spots but now it has spread to almost his whole leg. Is this common? If so, how long does it usually take to clear up?

58. Shirley currently we so not have the x-Large T.U.S.H. harness available which would be ideal for your boy. I am very sorry for that. We do though have the SupportRx harness which is our original support harness which allows for front control and hind end support through the belly wrap. It is very affordably priced and still a great option to consider.

59. DR YOU RECOMEND THE SPECIAL HARNESS BUT I HAVE A ENGLISH MASTIE WHO WEIGH ABOUT 135 LB. WHAT WOULD YOU THINK WOULD BE THE BEST. I’M GOING TO PICK HIM UP THIS AFTERNOON HE HAD
    SURGARY TPLO ON TUES.

60. Mark the answer is yes. You can totally just use it to help him go up and down the stairs. You should not have to carry him, you can simply use the harness to provide a little bit of support to the hind and that would be perfect.

61. TPLO surgery and stairs
    Read your guide and it is a wonderful help! One question to get our dog outside to go requires going down 2 or 3 steps to get outside (house level, 2 steps, outside level). Our dog is about 70lbs and we have gotten SupportRx harness (mostly for the car), Can we just use the back part to help him up/ down the stairs? Does he need the support going up and down?, he is kind of heavy to lift

    thank you,

    Mark

62. Eva, I have to apologize for my delay. The holidays seemed to have set me back and I am sorry for that. As for you question about pain meds I am sure by this point that you got that figured out by calling your veterinarian. All of my post-ortho cases go home with NSAID’s and tramadol for pain at a minimum but your surgeon is the key determinant on that. As for your other dog and the need for preventative joint health supplements, again this really is up to your and your doctor. If we all live by the motto; An ounce of prevention is worth a pound of cure…then if the supplement can cause no harm and only potentially help in the long run then I would say yes. That being said..if a dog has perfect joint health from the start then there really in no need for additional supplementation. It is best to discuss this with her doctor and see what they think about her overall joint health situation. Again I am sorry that I was not here for you immediately but I hope you are both well. All the best, Dr.J

63. Uli, my 7 year old Staffie had TTA 3 days ago.His medications are:Meloxican once daily, Amoxyclav 500 1tbl twice daily. He is still in pain, can I give him Tramadol left from pre -surgery? Uli’s weight is 27kg, quite heavy for my low back. I ordered yesterday TTA Complete Package Guide, The support harnessRX and GlycanAid-HA. The second question is ; my other staffie is 6 year old, should I put her on Glycan tablet for prevention to avoid another surgery?

64. Kris normal walking around the house would be totally fine. What we are trying to avoid is any jumping, running, going up stairs etc. The initial days after surgery should be focused on resting with only breaks to go outside to use the bathroom. The reality is that they will tell you what they can and can not do, we just need to protect them form doing to much to soon. Good luck with Bullies recovery.

65. My dog bully has had surgery four days ago now I don’t have him crated. Generally he’s been sleeping and resting for about 23+ hours a day. He’s a bullmastiff boxer cross and generally quite the lazy fellow. The downstairs area is relatively small (about 30m2 and the outside area only about 20m2). He’s mostly inside at the moment but does love to sunbathe outside for parts of the day. Is he allowed to walk around the house freely on the odd occasion that he gets up to move around a little or should he be more confined to not move at all?? He’s on Tramal and metacam as well. What’s the sort of maximum that they’re usually allowed to be on their feet during a 24 he period. Also when doing his business (#2) obviously there’s some minor bending of the back legs going on. Is that ok?

66. Jeanie that is a great question in terms of what to do when you find us a few weeks into recovery. My suggestion would be to start around week two. The reason I say this is it is about the long haul/the big picture. Full recovery takes a full 6 months at the end of the day. The first week is all about reducing the inflammation and discomfort related to the surgery itself. Being that you are now 2.5 weeks out that initial surgery pain is resolved or resolving and you are ready to focus on healing and building strength. I wish you the best of luck with your dogs surgery. Dr.J

67. I came across your site looking for help after my dog had Acl surgery. There just isn’t a lot of information for canine rehab at home. So this is wonderful! My question is why dog is two weeks and three days post surgery…I would like to know where do I start in your program? Also if I can receive newsletters for week two and week three.
    Thank you so very much!

68. Victoria our T.U.S.H harness would be a great option for your dog. It makes supporting the helping them in and out of cars or up and down stairs much easier and safer. I have no problem with the A frame as long as it is slow and in full control. As for the cold laser, of course I am a big fan. Typically for my patients I will do this 2-3 times a week.

69. Beverley, there is no doubt that the first few weeks of recovery are stressful, especially when you have a playmate in the house. Here is what you need to remember though. #1 This painful period for both of you is temporary in the grand scheme of things. #2 It takes a good 6-8 weeks to form good scar tissue and callus formation where the bone was cut and plated. That being said you have to use your best judgement. The best thing to do is have your dog on a short leash even when you are in the house and our want them to be together, this way you have some form of control. To help with the stir crazy you need to simply spend more time with her playing mental games (with good treats of course) and doing your short control leash walking. Again you know your dogs best so just be careful.

70. In order to avoid stairs, is it okay for a dog to use a ramp immediately after ACL surgery? My ramp is one side of an agility A Frame. I cannot lift a 40# dog to get in and out for pottying, etc. Also, do you advise cold laser treatments? If so, how many and for how long?

71. Hi
    My 17mth boxer had her TTA op on 17/11/14 she is going stir crazy been crated 24hrs a day!!is she ok to walk around small room for short periods at a time? There’s no furniture in there so she cannot climb onto anything! My other worry is we have another boxer who is 7 mths old and at the moment they are completely seperate so that’s not helping her stress levels!! When can we introduce them I’m just worried about them getting giddy!! Thank you look forward to your reply. Beverley

72. Lisa first of all good luck with your dogs recovery. I totally understand how stressful it is especially in the early days after surgery. Second you can start GlycanAid HA right away. Third as for where to ice, this is not at all a stupid question. In the case of the TPLO I would have a tendency to provide cold therapy on both the front and the inside of the knee where the surgery was. That being said make sure you have a cloth in-between the ice and the leg. Hope this helps. Dr.J

73. Hi and Thanks for the great website! Just got my 71lb Golden home from TPLO so how soon should I start the Glycandaid-HA I’m about to order? Also, really stupid question, but what side of the leg do I ice? I assume the outside part where there are no sutures. 11-7-14

74. Gladys my best advice would be #1 your dog should have a hip X-ray to make sure there is not a bone spur that formed and #2 get your dog back on pain meds ASAP. I truly feel as if we do not give these FHO dogs the benefit of the doubt and continue with pain meds long enough, at least until they are using the leg 100% consistently. In my mind if a dog is not using the leg, then I always make sure first that pain is not a part of the equation. You need to discuss this with your veterinarian.

75. June unfortunately they are really all different in there recovery speed so it is impossible for me to say when she will not need the assistance. If possible it would be great to get her into a professional rehab program to accelerate her healing process.

76. I rescue a female lab mix and was hit by a car, vet perform a femur surgery to cut bone head since then she does not put the leg down, he told us that this will take up to 6 weeks. Time is almost up and nothing is seen. The muscle is very thin in the area. Help!

77. Surgery was last Saturday. When will she be able to at least walk without the Lift Me Up Harness. It is starting to leave her contact areas a bit raw. The medications indicate that a side affect is not being able to control bladder. After doing a full load of soiled urine bedding, There isn’t ANY DOUBT this is true. Her fur wreaks of urine and am not sure of the best method to protect her from being saturated, then cleaned/dried – without fussing with her too much. She loves her massages, as she is a Cushings and Thyroid dog.

78. Wendy it is true that her recovery may be slowed due to this disease but my biggest advice would be to understand that full recovery no matter cushiness or not, takes a FULL 6 months. This is the amount of time that I have seen that it takes to get everything balanced again. That said I strongly strongly encourage pet owners to not allow their dogs to be off leash until they are 100% positive that both hind legs are the same size and the dog is walking 100%, jogging 100% and running 100% while on leash before ever allowing them to be off-leash. Make sure you get used to feeling the comparing the muscle size and strength of both hind legs. I have a video on this at https://www.topdoghealth.com/rehabcenter. Best of luck, Dr.J

79. Thats great news Bonnie. Keep up the good work. Dr.J

80. Thanks. We’re today at the end of week 1, thank goodness. He’s doing well on Tramadol and Gabapentin. I have used ice therapy extensively throughout this week, and am convinced it helped tremendously.

81. Theresa the typical dose of tramadol is 1mg/lb body weight 3-4 times a day. You can check with your veterinarian about this. The Metacam is only an anti-inflammatory and not a true pain medication. It controls the discomfort related to inflammation. I am a fan of long term pain management so check with your vet about this. All the best, Dr.J

82. Theresa they truly are all different in the initial post operative phase. First off I would just want to make sure that her pain management drugs are correct and she is being covered pain wise. If she is then I would just focus on the guidelines of the 1st week of post op care outlines in our Free Home Rehab Guide. Recover is a slow progression and as long as you are seeing small improvements on a daily basis then I would be happy. All the best, Dr.J

83. Bonnie there is a product called Flex produced by ProLabs which is an interesting natural anti-inflammatory. Of course I hope they can still control his pain with opiods like tramadol 3-4 times a day. The other big natural anti-inflammatory is ICE…use it and use it well. Dr.J

84. Sally sorry for the big delay. In a situation like this you just have to make due with what you have. The key is control on the leash. Hills, bumpy terrain it does not really matter, the key is slow slow control. Hope all is well. Dr.J

85. Bailey my 33lbs 10yr old shepard/terrier mix just had surgery last Tuesday cruciate and luxating patella so week one is almost behind us. Your Web site is great thanks for all of the great info and I just ordered the Glycanaid-HA. She is also a cushings dog and I understand that because of the steroids she is on that it could slow down recovery but she does seem to be doing well. She seems to have her same energy but hates the crate so the vet gave me acepromezine to keep her calm and sleeping during the day when I’m at work. Anything you can share about her recovery as a cushings dog would be great. I’m hoping she doesn’t injure the other leg.

86. Another question. How much pain meds should my dog have. The vet only prescribed Meticam and I actually made her give me some tramadol. She gave me only 5 pills 50 mg each and said I can only give her 1/6 of a pill twice a day. I don’t think that is enough. I do have some liquid tramadol that one of my dogs had to take at a different time. It says to give 1/2 ml every 8 hours. It is 25mg. I don’t have a ml applicator only one by lbs. would I give that I her by weight? She is 15lbs. I really don’t want her to be in pain.

87. Angelica had surgery on Tuesday and its two days later. When I take her out to potty she won’t use her leg at all to walk. She will use it to potty though and if she is standing still she will toe tap. Should she be using that hind leg to walk already?

88. I have a 93 pound animal control “mutt” who is simply gorgeous, with a torn ACL. I’m seeing a surgeon this week, however, I already know he cannot take anti-inflammatory meds as he throws up, sometimes violently. I know it is standard procedure for dogs to be prescribed these after TPLO surgery. Is there an alternative med that he can be prescribed?

89. Hi
    I have lab 16months old just had her surgery tplo. My problem is we live in the country and where she goes to eliminate is in tall grass and bumpy. She will not go anywhere else. How can I help her not to do damage to her leg. It is also down a slight hill. I try to go slow but she is still a puppy and again do not want her to hurt herself,
    Thanks Sally

90. Kristaan, I would not call this a set back only because you are still just fresh out of surgery. If you are really concerned about the use of his leg I would definitely call the surgeon and have him checked out. They may have to “tweak” his pain meds. There is no doubt that all dogs recovery differently, especially within the first few weeks. I have some patients who use the leg immediately and some they dont put it down for a good 2 weeks, but it is best to have your veterinarian check and make sure that all is well. Hope this helps and good luck. Dr.J

91. Our Rottie, PeeWee, had ACL surgery last Thursday – came home Friday with a full leg pressure bandage around his leg. Monday the bandage was removed. Now when he is “walking” it seems worse than before. I know your site says there are some set backs. Is this one of them? I am guessing so, since he doesn’t have the support around his leg from the huge pressure bandage?? Also, only done #2 once now.

92. Yes she has two weeks worth and she is very relaxed. She is doing well and the pain seems managed. Thank you!

93. Awesome woody. The first week is always the hardest. Just make sure that her pain is under control at this point. I often see that many veterinarians do not continue pain medications for long enough. For my patients I start with 2 weeks of pain medications..then I recheck them and often I will continue with this medication for another week after that point but in some cases if the dog is really really doing well we will stop with the meds at 2 weeks.

94. Thank you for all of this valuable information Dr. James!! Good stuff:) Bella is on week one and is being a big baby but we are following instructions and giving her lots of love!

95. Alex this is totally normal in the first days after surgery. Often it is a mix of pain from surgery and stress from the experience. I would say just make sure you are on the right pain medications, which should include an anti-inflammatory and a pain medication like tramadol. Otherwise a whole lot of love like you are doing and this should pass. good luck. Dr.J

96. Is the day after surgery ,and my dog got very needy, she is very social but she wants more and more comfort form me, is this normal? is because the stress of the traumatic surgery? I’m walking her how you recommend, i’m massaging her already, and icing…in the order that you recommended.
    What else I can do to make her feel better! Is killing me to have her on the crate, she never been in only traveling overseas. Thank you for your time and your incredible web!!!!!

97. Leslie the short answer to this is yes and no. They big question is whether the clicking is related to any associated limping when you are out walking. I know you mentioned that it was when you were doing the passive range of motion but try listening during a walk. If there is no limping associated with this then I would just give this some time and of course discuss this with your veterinarian. All the best, Dr.J

98. Dr. St. Clair, I will definitely share your site with Emmett’s doctors. Emm is feeling stronger with each day. He keeps trying to pull on the lead and is getting quite restless in his kennel. So I have been taking him on more walks for shorter time to break up his day. He also has been trying to kick dirt after his potty breaks. Today we tried the bicycling exercise for the first time and I noticed a click in his knee. He let me do this for a few times but then looked at me as though to stay “that’s enough'” Is the clicking normal? He’s only five days out of surgery.

99. Leslie from the sound of things you are doing fine. It is very common for them to lay on the “bad” leg…they do this as a protective measure. As for the videos…we are looking into why some people have problems viewing on the iPad. You can find all of the videos on you tube if you simply search for topdoghealth inside of you tube. Don’t be scared to do the PROM but if he is weight bearing on the leg consistently while walking then you can skip the PROM exercises if you don’t feel comfortable with it. Make sure if you feel like the information we provided is valuable to you and your dog please share it with the veterinarian who did the surgery. This information is all free for everyone whose dog is going through major ortho surgery. Good luck and just stay consistent increasing the activity level slowly day after day.

100. My dog Emmett is a three yr old Blue Heeler. He had his surgery Friday. He came home the same day. Emm and I were sent home with NO information. No pamphlet, no directives, nothing. I’m so thankful to have found your website prior to his surgery. Emm goes out to do his business tripod style. However he does put his lame leg down to brace himself for pooping. Is this okay? I have been unable to view your videos with my iPad. I was able to find a few other videos for PROM and massage on YouTube. So far I have been icing him and massaging him all over. I also did flex his ankle a bit but have been hesitant to work his hip or knee. (Although he does lay on it and bend it sitting up). I guess I am asking if there is anything I am doing wrong, or if there is something more I could be doing for him.

101. All set Kelia…we sent that for you.

102. Need week 2 rehab instructions please

103. Paula I am a bit late for your immediate question. The big picture is that FULL RECOVERY is going to take a good 6 months. Make sure you visit and watch the videos that I have in our online rehab center https://www.topdoghealth.com/rehabcenter. There is a video on measure muscle that is very important. Glad Rocky is healing well. Dr.J

104. Hello – my Dog – 130lb Rotweiller had surgery Aug 6th – one week ago. Should I be on week one or week 2 for his Rehab? If I should be on week 2 – could you send me week 2 Rehab instructions – so I can keep on track?
     Thank you so much – your guide and instuctions have been awesome! Rocky is doing well and seems to be on track to what you are saying I should expect! (oh and I was the very nervous owner!) thanks again. Paula

105. Sally this can be pain or a sign of anxiety. I would call your veterinarian to just discuss this with them and see if they can tweak his pain meds first or then need to run a quick chemistry to make sure his kidneys are doing ok.

106. Annette, the guidelines for recovery for MPL surgery are the same. It is all about conservative management after surgery…allowing the body to heal properly and then implementing the right strengthening exercises into your daily routine after the surgery. I would just focus on one knee at a time and you should be totally fine. He has is whole life ahead of him and overall the surgery to correct these is very successful.

107. Rex is home. he is doing so well. the other dog (pugs) is not bothering him. Rex is eating and drinking and eliminating. i have a large yard with a large dog pillow bed that they use outside. Rex was tired after eli inating and just gently walked to the pillow and laid down.
     question: i notice that he seems to begin panting with mouth open and closed just when he is resting, is this due to pain? also notice he is very thirsty, is that normal?

108. Have a 18 month Cavalier KC that has both back knee caps floating. Luxating Patella. Oscar has had surgery on his left back knee but only to pin the knee cap in place. It was unsuccessful. I cant help but blame myself for his recovery and it failing. He has to have further surgery on the same knee to do the full surgery by cutting the cartlidge attached to the bone make the groove deeper then put it back together. Both knees were grade three. The left is a grade 1 after the last surgery. I am really anxious about recovery the second surgery and then surgery on the right knee. I have received your emails on recovery for ACL, should I follow the same recovery instructions?

109. Sally I think anyone dealing with this your plate would naturally be overwhelmed. As for Rex, yes I would have a tendency to take the conservative route with recovery and focus more on slow/controlled and time. I am constantly telling people that full recovery takes 6 months and it is better to be conservative over time then aggressive. Allow the body to heal itself and adjust over time. No doubt dealing with both dogs is going to be a challenge which is only going to be more difficult come 4-8 weeks out of surgery. I think initially keeping them isolate is going to be critical and you are going to have to just give each dog “Their time” with you. It is going to be hard but you can do this, I am sure. Good luck. :) Dr.J

110. my dog Rex is going in to have 2 sugeries; FHO on left hip and MPL on right knee. he was hit by a car b4 i rescued him. ive read everything u have on both surgeries, however the hip is one that need movement during recovery and the knee is more slow and controlled recovery. do i just follow the slow and controlled for both? should i do more hands-on movement whith the hip during massage time?
     im very worried about activity level since he is so hyper (boxer/red healer) . i also have another dog, smaller and when Rex gets his surgery (aug 1st) the other dog will want to play. ive set up a gated area in bedroom, what else can i do for the other dog? feeling overwhelmed already and not even had the surgery yet.
     thanks

111. Lisa the first thing I would say is yes this can still happen even for those who do everything right after the first surgery. The problem is there is no way of knowing if there was partial damage to the other ACL that has been going on for a long time. Many times dog injury both at the same time but one is worse than the other so the focus is on the worst side. Yes the elevate liver values can be related to the non-steriodal use, but once you stop with this medication the number should improve quickly. That being said you can always discuss with your doctor the use of SAM-E (A liver health anti-oxidant) to help the liver cleanse. My question to you would be after the first surgery did you provide your dog with a comprehensive joint health supplement and if so which one had you been using? In my world this is critical for life time use after a joint injury such as an ACL tear. Looking forward to your response.

112. Lois you are very welcome and good luck with everything. If you need us just ask.

113. Lali, Rovera is fine. This is just another generic of the original Rimadyl which is a great twice a day anti-inflammatory. By now Eva should be doing better now that the initial pain of surgery is less. Just continue to be conservative with the recovery and follow the guidelines that I laid out and all should be well.

114. Dear Dr StClair-my peekaboo had ACL surgery last june-she has now had the right ACL surgically repaired today-it’s been a tough-heartbreaking long road. I did everything I was told to do and she still ruptured her other stifle. Do we have bad luck or is this common? I’m over come with fear,dread and greif for my poor girl? She was finally after one year getting around beautifully with no metacam or limping then POW! also her liver enzymes are elevated. Is this from metacam? or any steroid? Thanks-Lisa-heartbroken

115. Dr. St.Clair,
     Thank you for your response.She has been on an excellent joint supplement all her life. However, I was very impressed with Glycandaid and will probably purchase when mine run out.
     We found out that she definitely has fully torn both legs and will have the first surgery this month.I will reread/rewatch all your info prior to the second surgery in the future. Thank you so very much for all this wonderful information.

116. Hello again, Dr.J. Ok, Eva (my weim) just out from tplo surgery. The doc said that beside AcL she also torn her miniscus as well and there are signs of early arthrutis. I already got the supplements from web( the one you recomend. So , at this point how worry we should be about her recovery? And is Rovera 75 mg is good to keep her confy and pain free or I should ask for different meds? Thank you for helping us, Lali

117. Lois…from the sounds of it your dog has bilateral (both sides) partial ACL tears. The best course of action is to have this knees evaluated by an expert with her under sedation…..I will tell you this…all partial tears will eventually become full tears. That being said in some smaller dogs we have rehabbed them with partial tears and the dogs have not gone on to fully tear the ACL ligament…of course that was with aggressive physical therapy and promotion of scar tissue development. If your dog has partial tears, depending on the degree, often surgery is no doubt the best option. As for you seeing anything on the X-ray…you won’t. The ACL ligament is a soft tissue structure and you can not see this on an X-ray. All that being said..moving forward surgery or not…it would be a good idea to get her started on a really good joint support supplement moving forward in her life. Hope this helps and if you have any further questions please ask.

118. Heidi…when it comes to icing post-op I would have to say the more the better. It is common for people who have a similar surgery or total knee replacement to be on consistent cooling devices for the first 72 hrs. If you can do the icing every few hours that would be great. Cold therapy is by far the best anti-inflammatory and pain medication that is naturally available.

119. Lali that is a great question..it really all depends on how much icing they do immediately after the surgery and the few day post op. I would discuss this with your veterinary team. Icing is best for 72 hours post-op and immediately following any therapy when inflammation is going to be induced. If you are doing aggressive therapy and you feel the joint and it is hot or painful then you would use cold therapy in this immediate situation.

120. Cindy great question. Depending on the situation if your dog is in a cast for a period of time after surgery then you can’t really start many of the first weeks for therapy…that being said once the cast comes off that is when you should start week one…the only thing that is different is that you would not use the cold therapy..you could move straight to the moist heat therapy…but everything else would stay the same. Good luck.

121. Dawn, these videos are all hosted on you tube and therefore should not have a problem playing on an iPad. If you can not get them on the website you can simply go to you tube and search for topdoghealth and find them there. Hope this helps.

122. Dr. StClair,
     Thank you for this wealth of information.Our 4yo Great Dane was diagnosed physically by our Vet.Then another Vet (sitter) also looked at her and agreed there was a issue.Then we took her to a specialist who took xrays and agreed that both legs had ACL problems.My problem is that after giving her 2 wks of anti-inflammatory pills and rest, she appears fine. She has never been in physical pain, but had a slight limp on/off for a few months.Plus she didn’t put weight on the left leg 2 wks ago but now does.My concern is that we are being too aggressive and should postpone such a serious operation.I would really appreciate your input.My husband and I looked at the DVD of her xrays and didn’t see anything.Of course we don’t have an experienced eye. Thank You, Mrs. Lois Hansen

123. Hello. My choc. lab just had TTA surgery yesterday. We are doing the cold therapy on her leg but how often are we suppose to do it? ( I see it says for the 1st 72 hrs) , but is it 3x a day , every few hrs? thanks for your help.

124. Dr.J. We are having tplo on July 7. Im little confuse about when is to do icing and when to start moist heat. My dog will spend 2-3 nights at the hospital after surgery. Thank you

125. My dog Abby had MPL surgery on her right rear leg on Tues, June 24. Abby is a four year old yorkie/bichon. The Vet has her in a cast for two weeks with weekly check ups. Cast should stay dry and Abby confined to crate except for potty breaks.

     My question is how do I apply the week 1 instructions? Should I start after the cast comes off? We have been giving her massages but leaving her leg alone.

     Thanks for your help!
     Cindy

126. I am having problems getting the videos on my iPad. Are they not compatible with apple products?

127. Thanks. I guess she just has a high pain threshold. I’ll keep being bad cop and keep her under control!
     Cheers
     Elisa

128. Elisa, honestly that is amazing. Wow..she is one tough girl. She must be to happy to get rid of those bad hips. In the old days these dogs after FHO surgery really had no restrictions. Veterinarians wanted them to run out of the gate. For the last 10 years I have promoted a much different approach which is conservative in nature. The reason for this is that I want recovery to be safe and consistent over time. I am always try to avoid any compensation injuries. Your best bet of course is to keep her on a leash so that you do have more control. From the sounds of it she wants more exercise therefore I would suggest giving it to her but make sure it is controlled.

129. Hi Dr James
     My cocker spaniel had her second FHO last Tuesday. The first time around, it was easy to keep her calm but this time she is very excitable,pulling on the lead when I take her out and trying to bounce. I am pleased that she does not seem to be in much pain (she is not on any pain killers or anti-inflammatories on her vet’s advice) but I am stressing that she will hurt herself or ruin her stitches. Any advice welcome.
     Cheers Elisa

130. Pamela that is simply because in general far more larger dogs have orthopedic surgery than these smaller dogs. Not all patellar luxations require surgery. I did and ACL yesterday on a 6 lb yorkie but in general we do not see a lot of these.

131. Cheryl it is common for some dogs the first few days after major surgery like this to not eat as well. Hope now two days later he is doing better.

132. Just about all of these questions and recommendations are for LARGE dog. I have a 6 lb. Yorkie who just had surgery for luxation of left patella. I understood it is mostly the smaller breeds experiencing this poor genetic bone formation. I don’t see you so much addressing the itty bitty dogs.

133. sorry he had TTA

134. Logan had Surgery on 6/9/14 and is coming home today in the evening 6/10/14 I called to check on him and he had issues with vomiting and will not eat, is this normal?

135. Laura, that is a great question and a tough one to answer, only because there are so many variables…such as…are you using a large crate or an x-pen or confining her to a room? Also is she a pretty mellow dog or is she really active? I would say that maybe being home for one of two days immediately post-surgery would help you gauge how she is going to do. :) All the best, Dr.J

136. Our 4 year old lab is going to have TPLO surgery in the next couple of weeks. Your Rehabilitation Guide is priceless! Thank you for offering it to all of us nervous pet parents.

     My question is this: How important do you think it is for someone to be home with Scout at all times during the first week or two of recovery? We have the house prepared and know where we’ll confine her. Am I just being an over-protective mom thinking she’ll need constant observation? :-)

     Thanks!
     Laura Schofield

137. Terri absolutely you can use a heating pad with a moist cloth. I would just make sure you are beside your dog monitoring for the 10-15 min of therapy. PS. You are so welcome. We are humbled to be able to help.

138. Hi, day 2 of Jake’s recovery! I know I don’t do ‘warm moist heat’ yet, but could use a little clarification…can this be accomplished with a heating pad wrapped in a damp washcloth? The icing works like a charm! Thanks for this fabulous website!

139. Lisa 3 times a day is just the reasonable standard but yes you can ice more often than that….no doubt.

140. Hello Dr. StClair,
     I was wondering how often I can ice the knee after surgery (during the 72hours) My dog has substantial swelling and I would like to do it more than the 3 times a day that was advised by her surgeon, but I don’t want to overice….thank you!

141. Marlene… I would not say you are over reacting…you are a loving mom…worried about your baby. That being said…those incidents are not good and you need to avoid them in the future. The farther in recovery they are the better and more comfortable and confident they are…and you need to be conservative with them. It takes a good 6-8 weeks for scar tissue/callus formation to occur. The cut bone needs to heal for full success. More importantly I worry about the other hind leg…bearing all of the weight and explosion of this incidents. It is so common that dogs within the first year tear the other hind leg ACL and we don’t want that to happen…therefore you need to figure out how you are going to prevent future injury and future explosive activity. Make sure you also have her on a really good joint supplement moving forward. Whether you have to crate her or tie her leash to you belt..you need to avoid future situations like this…

142. Michelle, it is not uncommon for dogs with fentanyl patches to be off their normal appetite. Opiods like, this though really effective in pain control, can set dogs off in their normal appetite. Most of the time within 24-48 hours of removing the patch they return back to normal appetite. If the decrease in appetite continues I would contact your veterinarian to discuss options. If you can try cooking some good whole food for him.

143. My G. Shepherd is almost 9 with the energy of a 3 yr. old. She had her TPLO surgery 4 weeks ago today and had her check up on Monday and the Vet said she is doing well. She has been walking on it since day one but she did had 2 incidences where she strained her knee – 1 she was a freight train leaving the Vets at her 2 week check up and did not want to walk on it but did so shortly after that, Then she was lying on the living room floor when someone knocked on the door not expecting that and she charged the door. We keep her in the dining room since she does not create well and I did not want to make it a worse situation for her and. She has been a great patient and remains calm most of the time with the help of 1/2 a sedative(ACE) twice a day. I think her knee looks like it is poking out when she walks but the Vet said no, and she will let us touch and rub the incision area. My fear is she has not been completely calm and she is not healing well and she pulls on the leash when take her out to potty but then again she is always pulling. Am I over reacting and being too worried?

144. My dog had tta surgery about 5 days ago. He had his fentanyl patch taken off yesterday. He still does not have a very good appetite, all I can get into him are a few treats and plain boiled chicken. Should I be worried yet?

145. John thats a bummer that she did completely tear it, though this is usually the case. I would just complete the loading dose for the first 4 weeks and then move on to the maintenance dose. Please keeps us updated on her progress. All the best, Dr.J

146. I have an 11 year old female Australian Shepherd who had a partial tear of her back right ACL. For the past month we have treated her with hydrotherapy, limited walks, and Rimadyl 25 mg. I also started her on a loading dose of GLYCANAID –HA x 1 wk ago. She was doing well but something happened and she now requires surgery for a complete tear. My question, should I maintain the load dose, 2 tabs/day, while she goes through your Top Dog Rehab program or switch her to the maintenance dose of 1/day? I am so glad that I found your site to help Lexie and I through this!!!!

147. Rebecca the fact that he needs both hind legs just means that your total recovery time is going to be longer. You are still looking outwards of 6 months to complete the whole process but that is totally fine and considering he is only 1 year old…he has his whole life ahead of him…so it is well worth the investment. As for the wheel chair, it is really up to you whether you think he needs it. Most of the time a good support harness is enough for these guys. Also make sure that you invest in a very good joint supplement to provide the optimal ingredients for his joints for the long haul. We are always here if you need us. Dr.J

148. My dog needs TPLO on both back legs. He is a 1 year old lab. The surgeries are going to be about 10 weeks apart. My question is this – is the rehab any different knowing he has two bad knees? I have a walkin wheels chair – will that be helpful in recovery?
     Thanks

149. Pat…all dogs respond to this surgery differently. At four days post-op I would focus on icing and good pain management first. If the dog is not toe touching after the first 10 days then I would be a bit more concerned. As I always say it is best to ask this same question to the surgeon and just get their feedback. Good luck. Dr.J

150. Sherri you are very very welcome. We just want the best for all of these dogs and educating you is the best way to helping them :)

151. Sara my suggestion to my clients with the same concern is to remove the collar when feeding the dog…you just need to stand there and monitor them. Once they are don’t eating you can then put the collar back on. No problem ;)

152. Dr. James, my Bichon had tplo surgery 4 days ago and she still isn’t putting any weight on her leg. Is this normal?

     Thank you

153. Thank you for this guide. My Russell Terrier just had the surgery on Wed. We spent the first weeks before the surgery handicapping the house. I appreciate the help.

154. My BC is having issues eating with the buster collar an doesnt was to eat… She needs to lose 10lbs. She had her FHO surgery yesterday.

     Would appriecate any tips also she always been a picky eater not always sure how many time a day should she be fed or how much

155. Angie it really is a hit or miss. Obviously the best case senario is for it to stay and the inflammation to go away. That said if there is already dysplasia there then surgery maybe your best option and for a Frenchie the FHO is a great option. Make sure if you do this surgery that you continue the pain meds for a while until she is really using the leg well. BTW I have a Frenchie also.

156. Michelle, it has to be on your side. We just checked them and they are functional. You can also go to you tube and search for topdoghealth and you will find them there. If you continue to have problems just tell me. Dr.J

157. Geraldine, slightly red and bruising can be normal but it is best to either take her in and have it checked to take a photo of it and bring it to the surgeon. That said…was she only given 7 days of NSAIDs? If you think she is in discomfort then I would ask to also get a RX of tramadol 3x day. I also would ask to continue the NSIADs if she is tolerating them well. Hope this helps. Dr.J

158. Hi, I have an 8 month old French Bulldog bitch, Lola. A couple of weeks ago she fell and dislocated her hip. We got her to the vet within the hour and he replaced the joint and fitted an ehmer sling. Unfortunately this came off and we took her back and as the hip was back in the vet decided to leave it as she seemed fine. Unfortunately the hip came out again and we again got to the vet within 30 minutes and once again it was replaced. She has had the ehmer on for a week so far, two more to go. On the xrays our vet saw dysplasia. In your opinion, and I understand that you have not seen the xrays or know the dog, but what are the chances of Lola´s leg staying in place once the ehmer has been removed. I have been researching dysplasia and luxation but am just interested in the chances of her being ok after this. I have also been looking at FHO as that is a route we may have to travel. Thank you in advance for your anticipated comments.

159. None of your videos work for me. Am I doing something wrong? Thank you for all your help. My 40 lb collie mix had a tta surgery last year and we are up for round 2 in a week. You helped me so much the first time, I have to use you again!

160. how should the wound site be looking after 4 days? the site looks slightly red & bruised? she has another 3 days of A/Ss to take, but still seems to be in quite a lot of pain? How does this sound to you in terms of recovery? Kora is a German Shepherd x greyhound approx 3 yrs old.

161. Catherine you will be totally fine…keep you mindset calm and confident. You are just going to be there to protect her from overactivity and as for the harness it is there to just support her a little if she needs it. The 4 stairs in and out will be totally fine as long as she is not running and exploding up them. I totally understand the anxiety and stress for the unknown especially when we love them so much but you will be fine. All the best, Dr.J

162. Mary sorry for the delay in my message. I am a few days behind with all the questions I get. I apologize but I really could not add any value to your questions because this really is a question that the hospital where the surgery was done needs to answer. Hope all is well now.

163. My 11 year old Shepard/lab is going to have the surgery in 6 days on your right rear leg for the cruciate. I am so affraid that I will not do this well. I have purchased two inclosures for her 4’X4′. One for the bedroom and one for the dinning room (for week 2 or 3) What I am affraid of is that I live in a old house and its 4 steps up to the house and down out of the house. I have been practicing with a sling this week so we are ready for using one. I want her to be prepared and me as well. Your videos have helped in many ways and have frightened me too. She is 11. I very good health. It appears that she will be down 99% of the time especially the 1st week. I will keep her in the bedroom. I work so she will be left quiet all day. Will she be able to get up on her own when I go to take her out? How much lift am I to do when going down the steps to go out?? (I do have a ramp but its new to her) I have been working on my mindset on this. But worried that I can keep her safe. And do the best for her.

164. TPLO surgery was yesterday. The bandage is sliding down. Is it really ok to take it off.

165. Jon this is a great question…the answer really is both. No you should not extended it back far enough that it really hurts…..but yes you should slowly work on stretching and improving the range of motion. This takes time and as we all know stretching is not the most comfortable activity. I have a page in the home rehab guide on this and a video to help you as well. As always it really is best to visit a professional canine rehab facility so that either they can perform this for you or at least show you exactly how to do it with your dog. Hope this helps.

166. Diane yes it is very common for this to happen. As to when you should start back on the Deramaxx I can not make any recommendations and would have to leave that up to you and your veterinarian. Since I don’t have a personal relationship with your dog by law I can’t make any specific recommendations like this. I am very sorry but I am sure you understand. I with you the best this her recovery.

167. Barbara, you are very very welcome. It is my pleasure to be here and help as many people as I can. I appreciate you taking the time to say thank you. It always helps to hear these nice words. All the best, Dr.J

168. On Tuesday March 4th my 105 pound mix breed dog had FHO surgery after a botched (my opinion) THR. He seems to be doing great. My question is with the therapy. It seems to give him some discomfort when I extend his femur backwards. The vet said that it was normal and to work through it. I read that it shouldn’t hurt and I also read that it’s normal. What’s you opinion?

169. 2 questions. My dog had her right leg repaired 3 years ago and now her left leg. Is this common after 3 years to tear the other leg ? Also when should she start back on Dermaxx after surgery and for how long?

170. Dr.St.Claire,
     This is simply a heart felt thank you note. You have answered questions for me about my dog’s TPLO recovery aloing the way and then he had to have 2 lateral sutures put in same stifle 4 days ago.
     We were 13 weeks out on the TPLO.

     Well, after this new surgery I couldn’t believe how anxious I was about his homecoming, his pain, and difficulty walking. Then week 1 rehab notes came and I read the booklet again.

     Thank you, thank you! The information is so reassuring and calming. I know you have a practice and a family so I greatly appreciate the time you put in to help us all.
     Without these supports I think I would be so worried and wondering if he is ok. With them, I have info, focus,and knowledge of what to expect.
     Thank you so much.
     Barbara

171. Deborah many TPLO dogs are weight bearing day one out of surgery. Others it may take a week or so for the initial pain of surgery to subside. If you want to control the speed in the house the only thing you will be able to do is put a leash on her and tether her to you, or find someway of confining her into a room or specific area. As long as she has good footing ie. not slippery hard wood floors you should be fine you just don’t want her to say bolt towards the front door in the coming weeks because that kind of explosion could potential be detrimental, that is way we always talk about retrain and confining them.

172. Lisa there are tons of mental games/ activities that you can do with your dog when you are with them. Simply working on training and learning new tricks can occupy a lot of time and mental energy. For when you are not with him it is all about good toys, especially those that have hidden food treats. You could also put on the TV with animal shows if your dog pays attention to animal sounds. My dogs don’t do this but I know many who do. Good luck with everything and though not ground breaking I hope this helps some. Dr.J

173. Dr. St.Clair, First thank you for your willingness to share so much information. We are thrilled to have found your site. Our 95 lb. Leonberger just had TPLO surgery yesterday. How much weight should she be putting on the leg that had the surgery? We are working with the slow walks on the lead but when she walks around the house she walks with a faster gate to avoid putting too much weight on the leg. Should we be concerned?

174. Dr. St.Clair,
     I have a 106lb. male pit/mastiff who is 3 days post TPLO surgery. He’s doing very well. We keep him on a leash at all times and will put up a kennel in the family room to keep him confined when we have to leave him. I am looking for any suggestions you might have on how to keep him “occupied” but without activity. He’s starting to cry out in boredom – he had lots of activities pre-surgery and seems to be getting frustrated he can’t play, etc. I understand the importance for the restrictions, but wondered what we can offer him to keep his mind active. Any suggestions would be appreciated. (Thanks for the info you’ve provided on TPLO surgery…This information has helped us tremendously as we prepared and go through the recovery period.)

175. Lynn your current concept/plan is the right path. The bone still has to heal and it takes a good 8 weeks to form a callus. From there of course other compensation injuries to the front legs and back are always possible. Be conservative and recovery safely over time so that you will achieve the best results. All the best, Dr.J

176. Hi Dr. St. Clair
     I love your idea of weekly emails and video instructions for rehab! Everything on your website is excellent.

     My question is about my Bouvier who just had her second TTA. First one was last May and I thought I was very careful with her rehab, however she became lame on her other side and just had another TTA last Friday. The vet says I can be more aggressive with her rehab this time because her left knee is very stable. This week I’m following your instructions and my vet’s for the first week after surgery, but am wondering if there are any guidelines for being more aggressive, or do I simply allow her to do more each day until I notice some effect on the knee and then stop increasing the exercise until she is ready. I plan to keep her on leash for 6 months and gradually increase walks, various exercises, massage and PROM.

177. Judy I just set you ahead in the emails and set all of them. Hope this helps and best of luck with your dogs recovery. Dr.J

178. Dear Dr. James. I found your website 5 weeks after my dog had ACL surgery – she had Extracapsular Ligament repair. I really value all the info from the book and videos, and the weekly emails look so helpful. My problem is that I have just started receiving them, so I got Week 1 but really I need Week 5. Is there anyway you could possibly start me on Week5 please? I wish I’d found your site earlier. It’s fantastic. Thankyou so much.

179. Awesome Ingrid.

180. Ingrid….if she needs more space or privacy to do the bathroom thing…then it is ok to give her more. I would just not take her off leash. If she always has pooped out under the apple trees then I would take her there. Good luck. Dr.J

181. Nalu finally went poop this morning! I added 2 spoons of canned organic pumpkin to her small amount of food last night. I think that must of lubricated her bowels and helped her out!! Plus I walked her under the apple trees without her harness under her belly, just a short leash.

182. Grace…please understand I have to be slightly careful how I answer some of your questions because I do not have a personal patient/doctor relationship with your dog. These questions would of course be best for your doctor. That being said I can tell you that it is not all that uncommon for a dog to no defecate for a few days after surgery. If your dog is eating the poop will come. The longest I have personally seen a dog not defecate after surgery was 5 days and we helped it along with some over the counter Miralax for constipation. As for the freaking out…acepromazine is a commonly used sedative which obviously alters mentation so the freaking out barking could be associated…your dog I am sure feels vulnerable now after the surgery and it could have just been his way of warning something. Good luck and hope this helped some.

183. we brought Nalu, our husky/chow 6 yr. female, home from her knee tplo surgery after 5 days she still won’t poop in a short leash harnessed walk in front of the house. She always takes care of herself further out under the apple trees in the corner of the property. I have her on a diet sense she is in recuperation, but wondering if I should give her something to help her poop or walk her further out to try to poop?
     could it be the harness or the tramadol pain pills that doing it?

184. sorry, forgot to mention earlier, my shepherd had TPLO surgery. thanks

185. my german shepherd had surgery on thursday morning. He is on the following meds: tramadol 50mg,meloxicam 3.25mg,cephalexin 500mg,and just started acepromazine 25mg 1/2 tablet(has taken about 3 dosages)he has urinated 3 times since he came home.He has not,however, gone number 2. He urinated this morning,but did not want to later this evening and even before bedtime. Is this cause for concern? also, on our way back in the house he sensed something and freaked out barking, could this be from effects of the ACEPROMAZINE? your opinion is greatly appreciated.

186. Samson, What most people don’t realize is that dogs natural will put the injured leg under them when at rest. This is probably a protective mechanism and also allows them to more easily get up with the “good” leg on top. I know how stressful these first days can be..just be calm and take it one day at a time. Best of luck. Dr.J

187. I just brought samson home from TPLO surgery on his right hind knee. he went into his crate and layed down on the operated leg.He is resting comfortably. is it ok for him to sleep on that leg? they gave him morphin, so he is out of it.

188. Kimberly, this hurts me to hear this. Here is what I recommend and discuss this with your veterinarian. The way I medically manage my post -FHO dogs is this. I use Rimadyl twice a day along with tramadol three times a day at a dose of (1mg/lb). I keep my patients on these medications until they are using the surgery leg 100%. Obviously if they are not using our rehab facility then I make sure they follow our FHO post op booklet. This is my very basic protocol…often we go well beyond this. Make sure if your dog is staying on an NSAID for an extended period of time you have a blood chemistry run around 2 weeks after starting. I wish you the absolute best.

189. I have a 2 year old Lhasa Apso that just had FHO surgery on Tuesday 13th. Her pelvis is also broken in several places. She was prescribed Previcox 57 mg 1x daily. Last pill given this am (1 week today). She is walking in order to use the restroom but of course not putting any weight down on hind leg. What shall I start doing in order to get recovery started. I did call vet and let her know that I felt like my dog needed more pain pills for pain management.

190. Pauline, I would love to be able to help you but I would need more specifics on what surgery your dog had and when. As always the best advice would be from the surgeon who worked on your dog but I am here if you need addition advice or a different perspective.

191. When should I expect my dog to begin to put any weight on his repaired leg? Thanks.

192. Debbie the fluid that you are describing is called serosanguinous fluid and is described to be a clear bloody fluid. As you vet mentioned there is nothing to worry about and it will decrease little by little over the best week or so. Unfortunately when it comes to the dog knee it is really difficult to get any kind of bandage to stay so that you would not have to deal with the mess. No doubt i feel bad for you. You may want to confine him to an area that has hardwood floors or tile for a week or so. You could also contact your veterinarian again and just see if they would be willing to put a bandage the knee that would help keep things clean. Wish I could make this go away for you but unfortunately it is part of heal that is excessive in some dogs. If you did want to create your own bandage you could use a ACE bandage but you just have to extended it to go around his waist so that it stays up on the knee. Good luck :(

193. My 6 yr old couch potato yellow english lab is post TPLO surgery on right back knee. 5 days now & swelling has gone down very much from icing etc. But this morning we woke up to a few good size marks of blood & noticed where he bends joint there is a spot that will not stop oozing fluid/blood. Took him to our vet & they said no need for staple or stitch, to start applying the moist heat. It stops it, but the minute he loves it starts coming out again & getting blood all over our bedroom carpet & his bedding. Frustrating. is there a way to getfluid to stop ? Or is it a normal process of bloody fluid wanting to release from the stitched area? If this is standard, when will it stop & how man days to go through? We tucked an old tshirt between his legs to help blood not get all over. Help!!!

194. dear dr j, i cannot begin to tell you how grateful i am to have you to help with all these questions. at the vet things are mostly hectic, and whilst focussing on the dogs, we often forget about many things we wanted to ask. your advice is also indispensible, and you seem such a kind and thoughtful person. thank you once again. i feel much better now after reading your thoughts, and will do so. i have to admit nerves are quite frayed as i am not getting much sleep, sleeping close to dharma so i can listen and keep an eye on her – i have taken down the door to my dressing room (leading out of my bedroom), and put up a security gate, so she can see out – she was really getting stressed all cooped up. although i have not heard the clicking sound again, she definitely is a bit lame after the evaluation, could also be hurt from the pressure, but i understand it was necessary to test the sutures. so until i can have her checked out by my vet on monday, i make her lie on a carpet and pull her to the door, then support her best i can to go outside – i figured the less weight on her leg, the better. however, she is still clowning and goofing around in her room, i try to ignore that and hope she gets the message. how long does delivery of your SUPPORT RX-harnass to south africa take approximately? would you recommend the support rx or rather the t.u.s.h. harnass? kind regards, linky.

195. Frances, situations like this are the worst. Our dogs tell us that they FEEL much better and they are ready to do everything but the reality is they are not. Depending on the type of surgery, you really need to continue to be very conservative. You have invested a lot of time and money in this surgical repair and you don’t want compromise that. Dogs are function driven…if the pain is gone and they are ready to GO they want to GO, but as their protectors we need to in cases like this THINK for them and use honest good rational judgement. As always I tell people to alway consult with their veterinarian and follow their advice due to the fact that I do not have a client/patient relationship with your dog.

196. So first of all I am a BIG believe and promoter of second opinions and you should never full bad about this. I would definitly just be honest and tell your vet that you were worried and wanted another trained doctor to evaluate her. That being said I would wait until your veterinarian, the one who did the surgery and is responsible for her success to evaluate her. As for the clicking sound, yes this can related to the meniscus but unless it is accompanied by a defined lameness I would continue to be conservative in her recovery. The meniscus can heal on it own and i have had plenty of dogs with the same clicking sound and where not lame, and I simply super dosed our joint supplement GlycanAid HA and continued conservatively with therapy and with time this resolved. All said and done, time is on your side so wait and speak with your veterinarian.

     All the best, Dr.J

197. Carson is exhibiting no discomfort and really not happy with all the indoor constraints. He is an indoor dog, however he loves to go outside. How much slow walking is permissible, he is now on day 6 after surgery. Thank you!

198. dear dr j, thanks much for getting back to us so soon. i ommitted to introduce dharma. she is a 3.5year old boerboel (a south-african breed, mastiff x ?, and wheighs 40 kilograms (i think that is just over 80 lbs). thankfully the derm issue is slowly getting better, i am watching her whenever at home, and use the e-collar by day to prevent her from licking off the lotion. thanks also for your advice on where to start in your programme. another question, if i may – it has happened twice in the last week that i heard a distinct clicking sound when she squatted to reliever herself – i read about the meniscus, and feared that might be it. so, i took her to my vet last friday, unfortunately he is on leave, so the vet nurse had a look and said the suture is still holding fine, and that i should not worry, if it was the minuscus, i would not have heard it a second time…? anyway, dharma is putting weight on her leg, but i was still concerned, especially since i had waited so long the first time before realising something is wrong (bone malformations had already formed, and was surgically removed together with the ex-caps). so… not wanting to risk further complications or injury i took her to see another vet in town – just returned from that harrowing experience. i know the vet and thought him an excellent doctor, but now not so sure. i feel he was quite rough in examining her (could it be because she is someone elses patient, and there are some politics or unwritten rule i broke by going to a different doctor?). he confirmed the healthy leg is still fine, but checked for and found a drawer-motion and showed me the clicking sound (i could feel it when i put my hand over her knee and he moved it – and he confirmed that the original sutures are not holding up. she was operated on the 12th of december 2013.) was i wrong in visiting them today – should i have waited another week for my vet to return? could his examination just now have caused the drawer motion to occur….? i feel so helpless and frustrated – i just wanted to have her checked out, now it seems everything is about ego and politics. i have to mention also, from speaking with him, his philosophy about healing are along the speedy-recovery, non-confinement route, directly opposite to yours and my vet’s. personlly, i am more comfortable with your philosophy, as two family members both had back surgery, both received the same conservative post-op instructions, but only my mom, who followed them, healed properly. my aunt had to go back for a second op. there you go. did i cause her harm just now? i really want to tell my vet everything that happened, but what if he also gets mad at me? was i wrong? apologies for the lengthy email and getting all emotional, i am sure you are not here to play therapist, but it all feels such a lost cause..

199. Linky that is unfortunate about the derm problem. I hope this resolves quickly. As for the rehab I would read through the first few weeks instructions and gauge best where you think she is in terms of there physical ability and then start there. That said it never hurts to be more conservative and start around week 2 because the icing instructions are really for week 1 and you are past that. Good luck and we are here if you need us. All the best, Dr.J

200. dear dr james, thanks so much for the info and support – yes, i am a stress-ball, it seems one step forward, two steps back. we are in week 3 already (i was slow in making contact, and so regret this!). my dog has developed allergic contact dermatitis from one or our slow leash walks (i have allowed her to spend some supervised time on a blanket outside(grass/cement/insects?) and in spite of localised cortisone ointment, anti-histamines and antibiotics still scratches. i am watching her as far as possible, but need to return to work tomorrow – will this scratching motion be detrimental to her recovery – do i rather leave her at my vet for the day until allergic reaction has gone?
     also, do i now start her on your plan, as from week one, or do i rush things along, or start straight at week 3?
     thanks much for taking the time to read my mail.

201. No problem at all. Best of luck.

202. Thank you for replying! You are awesome to help all of us and the giving of your time. Carson had the TTA and comes home tomorrow, we will be diligent in following all your instructions. Thanks for the reply on the food selection as well.

203. To date jennifer the only side effects know with glucosamine are usually GI side effects like vomiting and diarrhea, though even those are rare. What the change in kidney values believe to be related to the Rimadyl? As for the supplements, made in the USA, is meaningless to me only because most these products though made here in the USA they are using foreign (most from China) ingredients. That is not to say that all China raw ingredients are bad but there simply are not the same degree of regulatory protections as we have here in the USA when it comes to raw materials. In our products we use all USA ingredient and only the best brand of each. In addition to that you have got to look at the actually formula. There are only a few products, beside ours that I trust on the market and I think are quality products. I hope the bloodworm comes back good and surgery can get scheduled soon.

204. Thank you for your response. I will be ordering the harness along with the supplements you recommended. Is there any concern with the supplements affecting a dog’s liver or kidneys? Her other lab that was a little concern was her creatinine, but no other labs were high to signify anything wrong with the kidneys. Besides the Rimadyl, she was on some treats that contain glucosamine and chondroitin and a treat that contains Omega 3, as well as her dog food that contained glucosamine, chondroitin, and Omega 3. We discontinue the dog food, but still giving her the treats (made in the USA. I wanted to make sure those are not also causing problems with her blood levels. We have tramadol for her, I just have been hesitant to give it to her. I don’t want her body to get used to it before surgery and then have to give her more after surgery for her pain. Hopefully her blood levels are normal tomorrow so we can get surgery scheduled soon. It was very scary for a week or two. Audi is her name and she is the light of our lives. It is hard to see her in pain and not be able to be the active dog she has always been. I’m sure once she has the surgery I will have more questions. This website is awesome! Thanks!

205. Jennifer you definitely should be supporting her and trying to prevent over stress of the good knee. You really should check out and consider purchasing our SupportRx harness. This will help a lot for both of you. We also have a brand new harness that we just launched called T.U.S.H. (The Ultimate Support Harness) which is amazing. It will be going live on our website on Friday. That being said you can simply call us and we can get one to you ASAP. 888-504-2220. My second comment for you would be honest consider, if you have not already, starting her on our joint supplement called GlycanAid HA. Please go to amazon.com and search for it and just read the reviews. These are really powerful and tell it like it is…coming from people just like you. The second thing would be to maximize your Omega 3’s. If you choose a fish oil you need 100mg/kg dose of EPA to work as a natural anti=inflammatory for the joints. Thats a lot by the way. TopDog also has an omega 3 that is rich in ETA and is the oil of the green lipped mussel of new zealand. This is a great product as well. Lastly you will really want to discuss alternatives to pain control with medications like tramadol or gabapentin. Good luck and we are hear anytime. Sorry for my delay. I have holiday..itis!

206. Honestly Frances in my mind and experience both surgeries are great and address the problem at hand. The recovery is also pretty parallel. If your surgeon does more TTA’s and is recommending that procedure then I would go with that. As with any surgery there can always be set backs. The majority of set-back are due to pet owners letting their dogs do to much to soon or the dog just over-doing it behind their parents back. If you follow our conservative guidelines and if possible find a local canine rehab facility in your area you will increase the chances of a more successful recovery. Good luck. As for the food…at this point I would rather not comment specifically. There are lots of decent foods on the market and just remember that blue buffalo is a marketing company in the business of selling dog food at a premium price. My suggestion is to simple turn the bag over and read through the ingredients and then go out and look through a ton more labels on bags and pick the best of that works for you both. Good luck ;)

207. Rich unfortunately due to some manufacturing problems with our supplier we had to discontinue this product. We are working on a complete redesign though currently and hope to come out with a whole new product come Summer 2014. That being said this does not help your situation. Your best bet is to go to a pharmacy that carries home health care products and you should be able to find something similar. Good luck.

208. Thanks David. I no doubt try my best to help as many people as I can. :)

209. Hi Dr. James,
     Not sure if this is really a week 1 question/comment. Our 85 lb lab was scheduled for TPLO last Thursday. She also has severe hip dysplasia. A week and a half prior to her scheduled surgery she had a reaction to Rimadyl. She basically quit eating and when we had blood work done her ALT was 1591. It has come down, and are to get it rechecked next week. Once things are back to normal, we will get her surgery rescheduled. She really is struggling getting up and down. We are worried about her injuring her other knee since most of her weight is being put on it. Should we be limiting her activity now to avoid the other knee blowing out?

210. My Presa is scheduled for a TTA soon and will have to have a one on the other knee as well. My question is how does the TTA compare to the TPLO? My vet suggest the TTA and the research I have done seems to also recommend the TTA. Will the recovery be as difficult as with the TPLO that others have e-mailed you about? Carson is approximately 4 years old, rescued, healthy and weighs 87 lbs. I feed Blue Buffalo and also would like to know I am being eccentric in this brand as it is expensive and I also have another large dog.
     Thank you so much for your time and all you do.

211. I watched your icing video and am interested in the therma vet wrap. However I can’t find it. Where can I find it or something similar?

212. I apologize Dr. J, that was kind of a loaded question. I think what you are doing is a wonderful thing. It sure helps to have a little moral support as well as helpful information. Thanks

213. Hi Dr.,
     Our 7 yr old Siberian husky ruptured his ACL 6 months ago. Our vet recommended the fishing line procedure, and rehab therapy at a local center. All went well, we did our rehab faithfully at home and have been careful with his activity but noticed now 6 months later he was limping again. He is scheduled for TPLO on Wed. 12/18. We are heartbroken to have to put our guy through this once again so soon. Question is…how do we manage the snow and ice when taking him out to relieve himself these first few weeks? Fortunately, the first surgery was in the summer. Thank you so much for your help and this awesome website.

214. David, rarely will you ever catch me saying anything bad about any other joint supplement on the market simply because that is not my style and also I have no way of knowing where (ie. USA, China or Middle East) they are getting their ingredients, nor do we know who actually makes the products. I can only speak about my company and our practices and our integrity and focus on using only the best of the best raw materials ONLY from the USA. In todays world the consumer ie. the masses overall tell the truth and I am a big believer in utilizing reviews. As of today our joint supplement GlycanAid HA is a 5 star rated product on Amazon with hundreds of reviews/testimonials from pet owners. I could not find independent reviews for this Joint Guard product outside of what is on their corporate website which I am always guarded about interpreting. That being said if your dog is doing well and you believe in the product then by all means continue using it.

215. Scott the only way to tell if there has been a re-injury is if there is progressive lameness and not improvement. Then you know there has been a disruption. It is very common to have set backs during recovery because yes they are animals and yes that “think” they are ready to go much earlier than they actually are. Just be ultra careful to the best of your ability.

216. Ive been using Joint Guard 600mg treats from Drs. Fosters and Smith for most of my dogs life (3 1/2yrs), and purchased Joint Care Premium Plus before his surgery and before I discovered your website. They both have glucosamine and MSM. I hope these products are as good as yours. There expensive and I have a lot left but want what’s best.

217. Hello Dr. James! My 7 year old 95lb lab mix underwent surgery this past Friday, December 6, 2013, and she is doing better than expected. However, my question is concerning how to tell if my dog has damage the surgical site and re-injured the area? If she has stretched or ruptured the prosthesis band? I have kept her in a small room no bigger than a full sized bed. Also, I have spent almost every second with her since she got home on Saturday. On Sunday we started the massage, passive range of motion exercise, and slow controlled leash walks three times a day. I have been making sure she is resting 99% of the time. However, today I had a work meeting and she managed to escape her confined area. She busted the wood baby gate and climbed over the gate. She then wandered up two stairs and on to the wood floor. She was alone for 45 minutes and greeted me at the front door when I arrived. To my understanding the greatest danger of surgical failure is when the dog feels good on the operated leg but insufficient healing has occurred to support vigorous activity. The other knee is already ruptured and she is having surgery to fix that one after she has recovered from this one. Thank you so much for everything. The book and weekly emails have been a lifesaver.

218. Lisa it is way to early to expect that from him. Right now you should focus on pain management, icing, PROM and massage. Once the initial pain from surgery subsides then you can focus on the techniques of sitting properly. Good luck.

219. Our 7 year old chow had a total hip replacement 3 days ago. He is recovering well but he avoids sitting straight down. He can turn over from one side to the other. Should i be conserned or is it to early to expect him to be able to sit?

220. Julie I think booties (if he has worn then before) would be a great idea. I would just do my best to keep him out of the snow and on plowed or shoveled walkways to do this business. Time to bust out that shovel :)

221. Lara I would totally stop this. The last thing you want to do is aggravate her. If she is toe touching well while on a slow controlled leash walk then you don’t necessarily have to do the PROM. Again this is not something that you want to force. Focus on pain control and what she allows you do comfortably. Good luck.

222. MY 18 month old Malamute is having TPLO next week. I live in the snowiest town in Alaska. Any suggestions for dealing with snow & ice post-op? Do you think booties would help? Unfortunately, the snow can’t all be removed so it has to be dealt with.

223. Thank you so much for doing this. My 80 lb shepherd mix had a tplo on wednesday (so we’re on day 3). She’s doing ok. Still hobbling on 3 legs, but toe touching when we go for short bathroom breaks. My question has to do with icing and PROM. She absolutely hates both of these and resists when we try PROM (like flexes her leg muscle so we cant move it unless we apply a lot of pressure, which makes me uncomfortable) and squirms like crazy if we try to ice it (and I have a towel down under the ice pack). Should I stop trying? I don’t want to injure her but I’m worried her healing will be delayed. Thank you again for providing such a needed service!!

224. Thank you for your quick response and once again your web-site in invaluable to anyone going thru this surgery with their pet

225. Dean, the benefit is this time around you know what he was like the last time around especially in those first 5 days post-op because you where there. The reality is that you can only do the best you can do and take the best precautions you can. I am sure from the sound of it you will be totally fine. The only thing I would say is that since you are having a person come over to help him you may want to get a support harness that they can use to help him around safely. i wish you and your big boy the best and I am sure all will be well.

     Regards, Dr.J

226. My dog is a 150 lbs bullmastiff and is going to have his 2nd TPLO surgery tommorrow. His last surgery was just over 2 years ago and the results were great. My question is this, during last rehab I worked locally and was able to come home during lunch and do the short leash walks, sit stand exercises, etc. I now work out of town and will have to have someone let him out just for bathroom break @ lunch. I will still be with him early morning and from 5:30 pm on. I am just really concerned and worried over the fact that he will be isolated without direct supervision for longer hours, especially part of that first crucial week. I do have a large circular pin that he will be isolated in and will be with him 24/7 for the first 5 days post surgery. I’m sure many working families face this issue but I just wanted to get your thoughts or suggestions. Thanks again and your TPLO rehab guide is awesome, I followed it step by step last time with wonderful results!

227. If she is still holding the leg up high after the TPLO surgery then this would be an indication that she is still in pain. I would call the surgeon and ask them to either evaluate her or adjust the pain meds. Keep us informed of her progress.

228. My dog had TPLO surgery 1 week ago and she is still holding her leg up high, and we are struggling with a small(1/2 inch) of incision healing. Do I walk her to potty area or wait until her leg comes down ?

229. For the first 72 hours it is recommended that you ice for 10-15 minutes at least 3-4 times a day if possible. The more icing the better.

230. Anna sorry I am late here. In a lot of these situations where they dog is not using the bathroom for extended periods of time I really have a tendency to blame or focus on the pain management. If they are in pain then they would not want to get up and go out to the bathroom. Considering that you are now seeing blood in the urine I would strongly advise you to get her back to your veterinarian so that they could test her urine for the UTI and also possibly adjust the pain management protocol. Best of luck and I hope she is ok.

231. How many times do you put ice pack per day for the first week home?

232. Our 2 and a half year old puppy had surgery on her rear left knee last Thursday, since we brought her home on Friday she hasn’t had a bowel movement and only pees once every 24 hours, It is now 6:30PM Sunday night and has not had a pee since @ 1:30AM last night, there was a little blood in her urine at that time. We are frantic and worried, is this normal. She is a small dog half Chihuahua and half miniature poodle and weighs 14 pounds. If you could give us some insight on this I would greatly appreciate it. Thank you so much Dr. St Clair.
     Anna

233. Jill you really can do either. You dont have to start with an exaggerated bicycle motion, just start slow and then build off of that based on how your dog feels.

234. my dog came home on Wed from his FHO surgery. when doing PROM – should I immediately start with the bicycle motion or should I start off just moving the back leg back and forth – then increasing a bit each time?

235. Terrie, absolutely. I would suggest that you purchase our SupportRX harness. YOu can call us at 888-504-2220 to make sure we get the right sizing. This will help you support her and is especially useful in the early stages. Best if you get this before surgery so that she can some home from the hospital with it. Best of luck with everything.

236. My 47 lb boxer will be having the lateral suture repair on Oct. 10th. I will be home with her for the first 10 days after surgery. My house is on a hill in a neighborhood of hills so there really isn’t any flat areas to walk her. Do you have suggestions as to how I handle her short controlled walks the first few weeks after surgery?

237. I would have to agree with the surgeon. Removing the plate of the first leg is no big deal at all. The discomfort should be minimal and I think it makes complete sense to do both at the same time. I wish you luck. Dr.J

238. My boxer mix Duke had a TPLO last august on his right leg with great recovery . However twice he became lame again so the doctors want to remove the metal plate. then 2 weeks ago he ruined his other knee , so now they are planning to do the TPLO on the left leg AND remove the plates and screws on the right! I am scared this will be too much but his surgeon assures me that it is in the dogs best interest.. Whatis your opinion….

239. Ginny with a bilateral surgery like this I am sure it is going to take him some to to even get started and simply get himself up. So I would say this is a good thing. Please tell me that he is still on pain management?

240. Our dog had bilateral ex cap last Thursday. Beginning yesterday, he wanted to be up more and really squirmed when I laid him down to rest. We have him confined to a smallish (13 x 20) kitchen, and he likes to walk slowly around our island every few hours or so. Is this overdoing it? He doesn’t like to walk much on bathroom breaks so this is the only walking he’s doing.

241. Your are soo welcome Dolores ;)

242. Thank your so much for being there.

243. Dolores…the answer to you question is absolutely. Your dog will totally recover no doubt..you just have give the appropriate time for recovery.

244. Honestly Dojoro, even with a partial tear the healing and recovery time is far greater then 10 days. You are trying to achieve some degree of extra capsular scar tissue formation which can take outwards of 12 weeks. Depending on the suspected degree of the partial tear, in many cases they are still surgical candidates and in my experience these dogs do great with extracapsular stabilization. The recovery faster because they still have some internal stability with the existing ACL that is still intact.

245. This is my dogs second TPLO . He became one of the statics you were talking about. What I would like to know is after the second knee is done will he be okay to play fetch and be a dog again?

246. Our 2.5 year old bichon shitzu, 16 lbs, has sports injury … “a partially torn ACL” caused by tripping down the stairs really fast in a might frenzied rush. Its been four days now … he is managing to eat some drink some, and with pain Rx every six hours… and Rx after a meal to help inflammation and pain. Why we have to wait 10 more days waiting for the injury to fix itself, is beyond me. Surgery is possible … we wait … and hope for Nature’s Fix. Do we have to wait this long?

247. Wendi, I would say that the support harness is really meant to be a security blanket, where if you are walking her and she stumbles or starts to fall that you can support her. Also it is great to help them go up stairs or get in and out of cars. It is awesome that you are thinking and concerned about added extra weight, due to decrease in exercise. I would recommend reducing her normal in-take by 10-15% unless she was a very active dog and now is not active at all I would reduce it more. You will have to gauge this over time. It is best to regularly feel the fat cover over her ribs, look at her waist and evaluate her belly, which is commonly referred to as the abdominal tuck. One thing I often recommend is that you can add water to her food which add help her still get the stomach satisfaction of feeling fuller without the added calories. I do this all the time with my dogs. Hope this helps and good luck.

248. Hi Dr. James,
     My labrador/golden retriever mix had tta a week ago today. The first couple of days were pretty rough but she is doing better now. I’m just wondering how long I need to continue using the sling support around her tummy whilst doing the controlled walking. She seems to put some weight on that leg already but I don’t want to push her too much.
     Also, I am concerned about how much to feed her. I am assuming that with less exercise than she previously had that I should cut back a bit? She LOVES her food but I worry that any extra weight could be detrimental?

249. I am fine with the stairs Tracy, but my thing would be only if you have him on leash and you control is speed. No running up and down the stairs..not because of risk to the surgery leg but risk to the other hind leg which is a big deal. Congrats on you new arrival.

250. My dog is currently recovering. I have a newborn so it is nearly impossible to avoid a set of 2 steps he needs to use to go out. He currently is not bearing weight on his injured leg – my surgeon said stairs are fine as long as he is not turning abruptly. He only uses these stairs a few times a day. What are your thoughts?

251. Honestly Meghan, even for those’s who’s dogs did not have surgery yet these conservative guidelines are a great foundation to follow. I would recommend if possible that you find a local canine rehab facility that has an underwater treadmill and a certified therapist. This would make a huge difference for Hazel as you will be able to also to focus on building the support muscles around the hip joint.

252. my eight year old pit mix Hazel has been struggling with hip dysplasia/arthritis for a few months. Because of her precondition our vet has recommended to avoid surgery for a “tweaked” ACL. We have started physical therapy at home coupled with laser heat therapy at the vet. We are basing our therapy on your cruciate therapy book, would you recommend any variations in therapy as the booklet seems to be geared towards recovery from surgery?

253. Lizzi, I feel your pain. It is awesome that she feels that good after only 1 week and no it is not a false sense that she feels good. The pain with an ACL tear is that the knee is unstable. The surgery corrects that immediately and some dogs bounce back really really quick. That being said you have got to get into a routine with her of restricted activity. Like children she is going to test, test, test you until you give in. If you put her in the crate and she cries and then you take her out…she wins and gets what she wants. Pavlov’s dog…she cries you let her out. Some people have keep a leash on the dog while in the house and move the dog with them from room to room. You just are going to have to find the best routine for the both of you. ;) Thanks for your kind words and we appreciate your willingness to help spread our word. All the best, Dr.J

254. Keith when you sign up…you are sent a confirmation email. Make sure you check your SPAM folder for that, especially with yahoo. This email contains a link called a double opt-in which just is a security feature on our side to make sure you are a real person requesting the information and not some automated hacker system. Once you click that link you are immediately taken to the download page. Unfortunately I don’t have a list of all the download pages. If you are unsuccessful send us an email at [email protected] and we will get it figured out for you. Good luck. Dr.J

255. I have tried to download the Home Rehab Guide for tta surgery several times now, but have never received it. I do receive your weekly column, and that is helpful, but could you email me the link to the guide? Thanks.

256. My 20 lb. Havanese had surgery 1 week ago and is already doing great with the slow leash-walking, and uses her injured leg quite well. She is still on Tramadol, Carprophen and Cephalexin. She seems to feel great with only a little pain. Her incision looks very good to me. I’m taking her in Thursday for removal of her stitches. That’s her 10 day mark. She’ll be very happy to have the hat removed too.

     We do our best to keep her quiet, which almost impossible with a Havenese. Is this a false feeling of healing for her? How do I keep a dog that is feeling good subdued? If I put her in the crate for any lenth of time, she cries and cries. I’m with her almost 24/7, so I’m quite vigilant with her activity. We also have another Havanese (her sister) and she feels wonderful. She doesn’t understand her playmate’s problem, and has tried to instigate play, which I nipped in the bud.

     You’re right…it’s stressful for the dog as well as the owner. Thank you so much for providing the helpful information on your website and the instructional videos. I would never have known how to slow leash-walk if I had not seen it demonstrated. The vet gives the owner information contained on one sheet of paper and sends you on your way. I’m going to ask him to recommend your website for more information if the client asks for it.

     You have been extremely helpful!

257. So Kathy in this case you really would want to consider purchasing a support harness like the one we have at topdoghealth.com. Our product works well and is reasonably priced. Ok from there you just have to remember that after the surgery that leg is going to feel better quickly. Now of course there is going to be the pain associated with the surgery but within a week most of the really big pain should be gone. The key here is pain pain pain management so you need to discuss that with your surgeon. Also you should download the home rehab guide from us and make sure you read through this prior to surgery and pick-up so that you can ask any pressing questions you have about post-op care when you pick her up. THe more informed you are that calmer you will be to deal with her recovery. BTW that right pain management will also help her deal with discomfort in the other leg. Last but not least, you are investing a lot into this surgery both emotionally and financially, make sure you invest in the right joint support and nutrition you can, and of course I would strongly encourage you to consdier topdog’s product GlycanAid HA. Please read the reviews on amazon as well about this. Remember out passion and specialty is supplying you with all the tools and information to make her better and comfortable after surgery. Good luck and you know where to find us.

258. Hi ~ okay my 4 year old shepherd is going in on July 30th for a tightrope procedure, i am very nervous about this whole thing ~ because i think her other acl is bad also ~ she is in bad shape ~ so give my some advice on how to help her thru i operated acl and one bad acl… If you can help I really would appreciate it so much.
     Kathy Walsh

259. I have not heard this from anyone but it could be one of two things. Because he is in pain he may be urine retaining because of pain of walking to go outside. Urine retention can lead to a urinary tract infection so I would make sure to have the urine check.

260. Robin, I am sorry to here this. Poor guy! I have not had really any experience with the brace and would love your feedback as time goes on about your experience. If possible I would recommend finding a canine rehab facility in your area that has an underwater treadmill and also a cold laser, both would be helpful. If you dont have access to a facility like this then I would recommend that you download the Topdog Home rehab guide available for free on topdoghealth.com. I would follow the course as if your dog did have surgery. I would continue with non-steriodal medications and pain management with tramadol 3x a day. I would also strongly strongly encourage you to invest in topdogs joint support supplement called GlycanAid HA if you have not already. Feel free to read other pet owners reviews of the product here on amazon. http://www.amazon.com/TopDog-Animal-Health-Joint-Rehabilitation/product-reviews/B004TLMNHE/ref=sr_1_1_cm_cr_acr_txt?ie=UTF8&showViewpoints=1. Wish you the best of luck and make sure you visit the online rehab center a topdog as well.

261. Have you ever experienced piddling in dogs after an ACL tear? My malamute is 12 yrs old & this has become more of a problem for him since the injury.

262. My 12 yr old malamute just tore his ACL 7/2/13 & we’re chosen to use an A-TRAC brace which arrived today. Any suggestions about rehabing w/ a brace?

263. Wray, everyone has there own kind of guidelines or protocols after surgery so I would just make sure that you follow your surgeons advice. Your dog has his entire life ahead of him so being conservative is never a bad thing allowing the surgery to heal. That being said you you download our Free TPLO Home Rehab Guide (you can find it here: https://topdoghealth.com/home-rehab-guides/tplo-tibial-plateau-leveling-osteotomy-guide/) you can see what we recommend in terms of time walking. Our instructions as also consevative by design. IN conjunction with that we also have tons of video on the website as well that you should find useful.

264. My dog(Brutus, a shepherd mix,75lbs) tore both ACL’s. First leg was done(TPLO) 10 weeks ago and right leg done 4wks ago. I was told I can do 2 15 min leash walks a day. Does this seem a little early considering it’s only been 4 weeks on second leg. First 6 wks we just went outside on leash to go. Is it because other leg is built up some? We had surgery done at VSS in St. Louis by Dr. Anderson. Really appreciate your help as I am in my 60’s and a stressor worried I might do something wrong. Thanks.