BY HEATHER DOWDY + MARLENE RICHARDSON
Shelby walk in the underwater treadmill under the supervision of Rod Newman of Canine Rehabilitation of Nashville after his TPLO surgery. Hydrotherapy is just one of the treatments used for post-surgery healing as well as for many other issues. Photo by Marlene Richardson.
Part One: Shelby’s Story
For those of you following us on social media, you’ve likely seen the pitiful photos of Shelby, our 12-year-old shepherd/collie mix, in his comfy cone of shame after orthopedic surgery. You see, Shelboo, as my husband and I like to call him (along with ShelbaToast, Sir Boosley, Booda, Mr. Boos and other embarrassing nicknames) had an unfortunate mishap in March.
Said mishap involved his itty bitty pittie sister, Briley, ramming into his knee with her concrete-block head during a playful wrestling match. Shelby cried and fell over. Briley felt instantly sorry and smothered his face with kisses. And when poor old Shelboo tried to stand and could not bear weight on his left leg, I feared the worst—that he’d torn his cruciate ligament.
I was unfortunately right. Of course, Shelby wasn’t alone. Injuries to the cruciate ligament (often referred to as a torn ACL) are common not only in humans, but in medium and large breed dogs over six years of age. (That said, it less commonly occurs in smaller dogs, dogs of all ages, and even occasionally in cats.)
Like Shelby, most pets suffering from some degree of injury to the cruciate ligament will exhibit lameness in the leg, refusing to bear weight or significantly limping. Your veterinarian can often palpate the injury by gently moving his hands just below and above the knee; if the two bones can be loosely moved back and forth (called a drawer), there is likely a tear to the ligament. There will also likely be swelling on the front of the knee. Radiographs can confirm whether the injury is a partial tear or a full tear.
Partial tears, or tears in dogs under 30 pounds, can often be treated without surgery. In milder cases, the pet may improve with six to eight weeks of strict rest and medical management. Nonsurgical alternative treatments, such as prolotherapy, may help resolve pain and lameness in many cases. Often referred to as nonsurgical ligament reconstruction, prolotherapy involves injecting medication around the knee joint, which causes the proliferation of new connective tissues, strengthening weak areas and creating stability. While the treatment can be helpful for many types of chronic musculoskeletal pain, it is not suitable for in all cases or if your pet suffers from a full cruciate ligament tear.
In Shelby’s case, his size (48 pounds) and his fully torn ligament took alternative treatments off the table, so we scheduled a consultation with Dr. Trey Calfee, the owner of Nashville Veterinary Specialists (NVS) and one of Middle Tennessee’s most respected veterinary surgeons. After weighing the surgical options, Dr. Calfee recommended performing a tibial plateau leveling osteotomy (more commonly known as TPLO surgery). According to Calfee, cruciate ligament ruptures are extremely common, and the surgical correction of these tears is the most common surgical procedure performed at NVS. “We repair approximately 150 of these injuries each year,” he says. “The TPLO is a highly successful surgery that is able to predictably return all types of dogs to a high level of function.”
Dr. Wesley Roach performs surgery at Nashville Veterinary Specialists. Photo courtesy NVS.
Contrary to what one might assume, TPLO doesn’t actually repair the ruptured ligament. Rather, it involves cutting and rotating the lower bone of the knee joint (tibia) to eliminate the abnormal sliding motion of the knee during normal activity.
While every surgery has inherent risks, we were confident that TPLO surgery offered Shelby’s best chance for returning to his prior active lifestyle. Of course, the surgery was the easy part. It’s the recovery period and rehabilitation process that pet guardians need to be ready for. While a dog can bear weight on the limb within a few days of surgery, it’s important that he is kept on strict cage rest and is on leash at all other times during the recovery process. Says Calfee, “We recommend that activity is strictly controlled for a minimum of ten weeks following a TPLO so the bone has time to heal. After that, there is a gradual return to normal activity over the course of another 2-4 weeks. I generally expect dogs to have continued improvement in limb function for four to five months post-operation.”
I won’t lie: I cried the day I brought poor Shelboo home from the clinic. His shaven leg was bruised and swollen, and a long stapled incision ran the length of his leg. He looked more pitiful than I could ever had imagined, and for a day or two, I hard a hard time imagining that he’d ever return to normal. But I believed in Calfee and in the process.
I also believed in Rod Newman, owner of Canine Rehabilitation of Nashville. He’d already worked wonders with MollyBear, our elderly chow mix, and I knew he’d have great rehabilitation options for Shelby’s recovery process. We gave Shelby about ten days to recover from surgery, then began the slow and gradual process of rehab. (For Williamson county folks, rehabilitation services are also available at Animalia Health and Wellness.)
Rod Newman of Canine Rehabilitation of Nashville helps post-surgery Shelby gain strength and balance using stability balls. Photo by Marlene Richardson.
The first few sessions involved therapeutic laser to help reduce pain and inflammation, which helped greatly along with prescribed pain medications. Newman showed us gentle range-of-motion stretches as well as massage techniques for keeping the scar line healthy. We practiced these at home several times per day to get Shelby off to a strong start.
Within a few weeks, Shelby was ready to get to work. Newman worked with him on agility-type training, such as walking over crossbars and bearing weight on stability balls. Our food-motivated friend was eager to please when tiny low-calorie treats were offered as incentives, and quickly learned his rehab routine. He also began walking in the Hydro-Physio underwater treadmill to rebuild lost muscle mass, increase strength and to improve his range of motion. Before too long, our biggest problem was trying to keep him calm and quiet!
Throughout his recovery, we gradually increased his daily walk from potty breaks to twice-a-day three minute walks and then to five-minute walks; from there, we built up to ten minute walks three times a day and so on. Newman continued to introduce new at-home exercises to build strength and use of the leg. I recorded his progress on video. Sure enough, day by day and week after week, Shelby progressed by leaps and bounds. Sixteen weeks post-op, on the Fourth of July weekend, Shelby’s own Independence Day came. He was finally free! (Insert the theme song from Rocky here.) As we watched him run and play with Briley for the first time since his injury, our hearts soared.
As is typical with many orthopedic surgeries, some arthritis can occur in the joints afterward, so Shelby takes a daily Glocusamine Chondroitin supplement (we like the chews from Pet Naturals) and we have pain medication on hand to offer when needed, such as after a long hike or an over-active afternoon at the dog park. But aside from occasional stiffness, his leg is good as new, and Shelboo is loving life again.
It’s been a long and expensive road to recovery (thank goodness for Care Credit and a helpful husband!) but I wouldn’t have it any other way. As I write this, Shelboo and Briley are chasing one another up and down the hall having the time of their lives. Shelby can enjoy just being a dog again. And that sort of unabashed joy is just something you can’t put a price on. – HEATHER DOWDY
Part Two: Zeus’ Story
Zeus was not long for this world; of this we were convinced. Our cherished twelve-year-old Newfoundland mix was aging quickly before our eyes; it was as though we were viewing a time-lapse video of deterioration with zero hope for a happy ending. Our arthritic “goofy Newfie” was clearly in an increasing amount of pain, straining and struggling more and more each day just to simply meander around the house. Wasn’t it just last year when the doggy daycare ladies had to keep putting him in time-outs to grant the other dogs some relief from his boundless playful energy? Wasn’t it just last week that he hurled himself four feet off the ground and into the back of a parked moving van just to greet the new neighbors? Wasn’t it just yesterday that he, with our younger pup in tow, sprang up the steps in the daily, thunderous routine to greet us at the door?
My husband and I initially attempted to manage Zeus’ symptoms with pain medication, anti-inflammatories and rest. We minimized his exercise to the point of virtually nothing, thinking physical activity would cause additional discomfort. We allowed him to become sedentary, which we soon learned was a huge and all-too-common mistake. In addition, the pain medications were wreaking havoc on his digestive tract. The day he was unable to hold himself up while popping a squat was the day we finally woke up and realized that our Zeus needed and deserved something better. He deserved rehabilitation.
Rod Newman of Canine Rehabilitation of Nashville performs cold-laser therapy on Zeus to reduce pain and inflammation in his joints. Photo by Marlene Richardson.
Our first consult with Rod Newman at Canine Rehabilitation of Nashville involved my tearful blabbering and a much-too-lengthy rendition of everything related to our beloved canine. Meanwhile, Zeus instantly trusted and took to Rod. (Dogs just always seem to know, don’t they?) I received a gentle but much needed lecture about active vs. passive recovery (the latter of which was our original, ineffective strategy). While Zeus wasn’t necessarily recovering from any one specific injury, his intensifying arthritis was causing him to overcompensate, which was in turn causing subsequent soreness in the muscles and joints he was favoring. The principle of active recovery still applied: through controlled activity (vs. rest) he would build and maintain more muscle mass and joint motion, decreasing stiffness and pain. After taking detailed baseline measurements, Rod designed a customized rehabilitation plan for Zeus: therapeutic laser and underwater treadmill at the clinic, and daily light exercise, range-of-motion and massage at home.
While I was vaguely familiar with the concept of hydrotherapy for people (think sweet little grannies in flowered bathing caps doing water aerobics), my jaw dropped in absolute awe watching Zeus cruise the underwater treadmill, in which the silly klutz actually appeared graceful! Zeus’ first session at .6 miles per hour lasted only four minutes, after which he was utterly exhausted for the remainder of the day. (We are still embarrassed to admit this was completely our fault for failing to exercise him enough under the justification of not wanting to exacerbate his pain.) Fortunately, it wasn’t too late to turn things around. Over the next few weeks, Rod gradually increased Zeus’ treadmill time, and soon Zeus was conquering that treadmill at 1 mile per hour for an entire ten minutes!
Prior to each treadmill session, Rod would sit on the cushy floor mat with an extremely relaxed Zeus, gently pressing a therapeutic laser wand to his stiff and achy joints. Zeus blissfully soaked up this low-level laser therapy and melted into each treatment like a sugar cube in a hot cup of tea. While the treatment sure appeared simple, the Vectra Genisys Class 3B Laser is quite sophisticated and delivers the ideal wavelength to penetrate the skin and reach the joints in order to reduce pain, inspire repair and rejuvenate impaired cells. In addition, it is proven to be a safe and effective alternative to the multitude of pain medicines and anti-inflammatories Zeus had been on for too long.
Zeus continues to become stronger and more mobile each day, with the added bonus of requiring less pain medicine. We are absolutely thrilled - blown away, really! – at the vast improvements we have seen in him since beginning his rehabilitation program. He has gained muscle and an increased range-of-motion, has less pain and more spunk, and is even able to play again with our younger pup, who never did quite understand why he stopped partaking in their collective shenanigans.
I shudder to think that merely a few months ago, we almost gave up all hope. Zeus may be a little grey, lumpy and wonky now that he’s a senior, and the “new normal” at our house may involve funky ramps and groovy rugs and completely mismatched orthopedic beds in every room, but to provide a long, healthy, happy and comfortable life is exactly what we signed up for when we adopted him twelve years ago. Thanks to Canine Rehabilitation of Nashville, we are now convinced that our big ol’ waggish pooch will continue to grace us with his adorable antics and slobbery kisses for some time to come. – MARLENE RICHARDSON
Nashville Veterinary Specialists
Pet Rehabilitation Programs
Canine Rehabilitation of Nashville
Animalia Health and Wellness