Post Operative Instructions: TPLO/MRIT Surgery
Alertness
Rover has been given an anesthetic today and will be drowsy and uncoordinated for up to 24 hours. For this reason, it is important to keep Rover away from stairs and decks and to keep Rover indoors in a quiet room the first night.
Food and Water
It is all right to make food and water available once Rover's coordination is back to normal. Some pets eat the 1st night but, others may not eat for a day or two. Many pets are nauseous for 24 hours after their surgery. Please contact us if this persists longer than 48 hours post-op.
Bandage Care
The goal of the bandage is to provide pressure to the surgical site to reduce swelling and improve patient comfort for the first few days. You may place a plastic baggy over the foot whenever you take your pet outside to prevent soiling of the bandage; immediately remove it when indoors. If the bandage slips below the incision or becomes soiled or wet before this time, please remove by simply cutting away a layer at a time but always remember to use caution and avoid cutting skin; or if you do not feel comfortable doing that, return to Midvalley Animal Clinic and we will remove and replace it for you. Bring your pet in for bandage removal in 3 days. We will check the incision at this time and usually the bandage does not need to be replaced.
~There is no additional cost for the bandage removal but an appointment is required~
IV Catheter:
Rover had an IV catheter placed in their leg today so there may be bruising in this area, but it should heal quickly. If Rover has a bandage on their leg when leaving the hospital, PLEASE REMOVE THIS BANDAGE ONE HOUR AFTER ARRIVING HOME. It is important that this bandage be removed this evening to prevent swelling.
Incision
The incision should be checked daily for redness, swelling, discharge, and pain. The incision should be dry, slightly red along the margins, and slightly swollen/thick on the edges. Call our office if you are concerned about the incision for any reason including:
a) Gaps in the incision - the edges should be touching without any gaps
b) Discharge-other than light crusting along the incision
c) Swelling-other than slightly raised skin near the edges.
Some bruising is normal and should resolve in 5-7 days. Sutures/staples need to be removed 14 days after the surgery. Do not allow Rover to lick or chew the incision for any amount of time. Please use an e-collar if you leave Rover unattended. No bathing until the sutures/staples are removed and the incision has completely healed.
~There is no additional cost for the suture/staple removal but an appointment is required~
Surgical findings
Emergency Services:
Emergency services are available after hours at Cottonwood Animal Hospital and E.R.. Their address is 6360 Highland Drive (801) 278-0505. You are responsible for all fees charged by the emergency clinic.
Medications
Rover has been sent home with three types of medications (antibiotics, NSAID pain medication, and a narcotic-like drug that also helps with pain control). Rover was given an injectable form of these medications with the surgery. If your pet is not nauseous you can give the Gabapentin (if prescribed) the night of the surgery before you go to bed. All medications should be started the morning following the procedure and all medications can be given at the same time. Please follow only the directions on the labels. Give only as directed by our veterinarian.
Next dose is due: #INPUT#
Activity restriction x 8 weeks
Please keep Rover in a comfortable, safe, indoor location with no stairs for the first 2 weeks following the procedure. You can make a temporary ramp with a sheet of plywood for large dogs. Rover may be groggy for the next few days. Rover may whine or appear more anxious then usual; this may indicate pain/discomfort or side effects of the medications. Please call our office for assistance with any medications adjustments, to schedule a recheck examination, or additional pain medications. Confine to one level/section of the house on carpeted floors. Limited, supervised access to stairs is recommended for weeks 2-8 following the procedure. Use baby gates to prevent free access. Use a belly band/sling for safety when walking across slick floors, going up/down stairs and during all physical therapy activities to prevent falling. (Continue use until Rover is steady on the leg). Please always use a short leash (4-6 ft) leash when taking Rover outside to urinate/defecate during this restricted period. Confine Rover to a small area/room/crate when unattended. Please do not allow Rover to run or jump during this restriction period. You should notice Rover beign to touching their toe down to the flood when walking within the first 2 weeks. Thereafter, leg use should steadily improve. If you notice a sudden deterioration or Rover stops using the leg at anytime after surgery, please call us for advice. An exam and x-rays may be needed to determine if an infection or implant failure has occurred. Rover will feel like using the leg normally before the bone is well healed. Continue the restriction during this difficult time when Rover is feeling "too" well. Failure to do so can result in serious healing problems and/or implant failure.
Progress exams
Please make an appointment to see the veterinarian 14 days following surgery for a progress exam. Knee function will be assessed at this time, skin sutures will be removed, and questions regarding physical therapy can be addressed. If Rover had a TPLO please make an appointment to see the veterinarian 8 weeks following surgery for progress x-rays. Rover may need additional x-rays 12 weeks after surgery. Complications with this procedure are rare, but possible. We recommend scheduling a recheck with your veterinarian for a re-evaluation if post surgical progress is slow or problems arise at any point in the rehabilitation period. An examination and/or x-rays may be required to fully assess Rover's surgical site. **Please note these follow up services (exam, x-rays, additional medications, bandages, etc.) are not included in Rover's original surgery fee and will result in additional charges** ~Bandage removal and suture removal will be done at no charge but an appointment is required.~
Physical therapy regimen
Our lives are often very busy, so if you must err, err on the "do less" side of these instructions.
Week 1:
Range of motion {ROM) exercise - Have Rover lie on his/her good side. Grip the front of the thigh with one hand and hold he foot with the other. Slowly push the foot up into flexion of knee then slowly pull the foot and push the thigh down and back into extension of the knee. Concentrate on the extension movement. Repeat this motion slowly and smoothly 10 times once daily. Flex and extend only to Rover's comfortable limit. Do not go to the point of creating pain or resentment. Following ROM, apply ice packs (wrapped in a thin cloth) to incision area. Baggies of frozen peas work well for this, or make an ice pack by freezing 2 parts isopropyl alcohol to one part water in a ziplock bag.
Massage - Do your best to calm Rover and get them used to rubbing motions of your hand. Start running your hand from the toes of the affected limb and up the leg using less pressure and building up one day at a time until you are able to apply moderate pressure. At this early phase in the rehab period, do not force any therapy if you notice that your dog is still uncomfortable in any way. Massage is done for 10 -15 min, 3-4 times a day.
Walking - Lay out a path that will allow you and Rover to turn corners and walk around objects on one level of the house with non-slip flooring or in your yard. Place Rover on a short leash. Walk slow enough so that Rover has to put each foot down and does not hop. If her/she is barely putting foot down, stop every few steps and ask Rover to back up a few steps. Walk your path for 5 minutes twice daily; add 5 minutes each week until your pet is walking at a normal pace at least 20 minutes twice daily and using the operated limp every step. Use small treats to encourage participation. Avoid walking locations they will result in uncontrolled activities, such as, meeting other dogs, chasing cats, excited kids, etc..
Week 2:
Moist heat application - Ten minutes prior to performing the exercise, apply a commercial moist heat product. Although you can use heating bottles or heating pads, moist heat has been shown to work more efficiently to penetrate the affected tissue better then dry heat. If you can't easily find one, you can improvise by wetting a washcloth with warm water. Be careful though that the heat you are applying is just right to the touch and will not cause burns.
Expanded ROM exercise - Have Rover lie on his/her good side. Apply a warm compress to knee for 5 minutes. Grip the front of the thigh with one hand and hold the foot with the other. Slowly push the foot up into flexion of all joints; hold for 5 seconds. Slowly pull the foot and push the thigh down and back into extension of all joints; hold for 5 seconds. Repeat this motion 10 times twice daily for 4 weeks. Again, do not go to the point of creating pain or resentment. Follow each session with 5-10 minutes of ice packs. (See week 1)
Massage - 10-15 minutes, 3-4 times daily (see week 1)
Week 3:
Moist heat - As needed; when you notice that your dog is using his leg consistently when walking, moist heat can be discontinued.
ROM - As needed; when you notice that your dog is using his leg consistently when walking ROM can be discontinued.
Sit/stand exercise - Have your pet repeatedly sit and stand for 10 repetitions twice daily. Use small treats to encourage participation. Do not push down on his/her rump. To encourage proper knee flexion squarely under his/her body, have Rover sit next to a wall so the knee doesn't swing out to the side. Continue for 4 weeks.
Massage - As needed.
Post-therapy icing - Icing after exercise is never a bad thing.
Week 4 - 5:
Moist heat - As needed
ROM - As needed
Slow, controlled leash walks - Increase time
Sit and stand - 10 reps, 3 - 4 times daily
Figure 8's - Simply walk Rover through an imaginary "8" on the ground. Start with a bigger 8 to encourage Rover to regain his/her balance and increase muscle strength.
Massage - Rover may stand or lie down. Perform both superficial skin massage & deeper muscle massage. Skin massage around the knee hunt involves using your hand loosely conformed to the surface of the skin; enough pressure is applied to move the skin relative to the underlying tissue. Muscle massage of the thigh and shin involves deeper kneading and pushing of the muscles. Perform massage for 10 - 15 minutes twice daily for 4 weeks. *** Note: If you notice your dog is limping or is uncomfortable with the increasing number of reps or exercises, you should revert to the previous week's level of activity until you feel that is able to tolerate the increased activity.
Week 6 -7:
Activity exercise - Place Rover on a short leash and have him/her walk at your side. Walk outside on even/solid footing for 20-30 minutes twice daily. Controlled leash walks with hill work - Let Rover walk slowly up and down an incline. By walking up an incline you are encouraging more weight to be place on the hind line. Again make sure that this is slow and controlled. Sit stand exercise - Increase repetitions Figure 8's - Increase repetitions ** Confirm appropriate healing with your veterinarian prior to the following increased physical therapy activities.***
Weeks 8-9:
Curb work - This type of exercise is best to increase muscle strength, girth and balance as well as improve flexion and extension of the affected limb. This activity is performed by simply stepping up and off a length of curb while walking with Rover.
Jogging exercise - On a short leash, intermittently jog and walk your dog for 10 minutes twice daily. Continue 4 weeks, gradually increasing tine and distance.
Stair work - It is ONLY AT THIS TIME after crucial repair surgery that climbing stairs is allowed. Be sure to provide support to Rover during the first few days by using a belly harness or a towel. Introduce walking up and down slowly starting with 3 stairs and increasing the number of stairs each day depending on the progress of Rover. At this time, it is not advisable to give Rover free access to the stairs. Keep him on a leash at all times and the stairs must be off limits when not doing stair work.
Swimming - Is a wonderful rehabilitation exercise when performed correctly. You may allow controlled swimming after week 6. Controlled swimming requires that Rover not jump or leap into the water; please walk Rover into the water until he/she is deep enough to swim. Throwing balls to fetch often can cause serious problems in the healing phase. Do not over extend Rover; start with short excursions (5 min), increase duration/ frequency gradually.
Week 10 Light play exercise - On a long leash, encourage playing and romping with Rover for 15 minutes twice daily. Use toys for teasing and tugging. Continue 2 weeks.
Supervised, off- leash or long leash activity - Ask your veterinarian if it is alright for Rover to have some off leash time. However this should be done under strict supervision from you. If Rover loves to jump, chase balls, toys, and run with other dogs, Rover's better off being on a leash at this time.
Controlled leash walks with hill work - Increase time and repetitions
Sit-to-stand exercise - Increased repetitions
Figure 8's - Increased repetitions
Curb work - Increased repetitions
Swimming - Increased time
LONG TERM LIFESTYLE
It is very common (30-40% of patients) for both knees to develop this ligament injury. Prevention is difficult; the most effective thing you can do toward prevention is to maintain Rover on the thin side of normal body weight and condition. Some patients will damage a cartilage pad in the joint (i.e. Meniscus) even after surgical stabilization; this may require a second surgery in the future. The prognosis for a dog treated with a TPLO to correct a ruptured cranial cruciate ligament repair is good to excellent. The majority of dogs return to a normal gait, level of activity and endurance. Following the 12 week recovery period, there are no recommended limitations to their lifestyle.
Using a trained veterinary rehabilitation center may be beneficial in Rover's recovery. We have listed the rehab center's in the area that we recommend. We are not associated with any of these places and recommend you do your research to find the right option for you and Rover.
Alta Dog Rehabilitation 7107 400 W #8, Midvale, UT 84047 (385) 226-5971
Utah Pet Rehab & Acupuncture Center, LLC 2896 E 3300 S, Salt Lake City, UT 84109 (435) 640-5451
Salt Lake Animal Physical Therapy LLC 349 E 900 S, Salt Lake City, UT 84111 (385) 354-7272
K-9 Rehab Center 698 W 500 S, West Bountiful, UT 84087 (801) 294-5960