What to Expect and How to Prepare for Rover 's TPLO/MRIT Surgery

Surgery Preparation Advice

The team at Midvalley Animal Clinic takes the relationship with our clients and patients very seriously. We want you to feel at ease entrusting us with your furry family member and are happy to answer any questions at any stage in the process. We have created this document in an effort to help We take pride in the services we provide and look forward to working with you to supply your pet with the very best of care. Please feel free to call or text us at (801) 269-1213 to discuss any of your pet's needs further.

If you would like a visual of what a TPLO entails, this youtube video demonstrates what a TPLO is and how we perform the surgery. https://www.youtube.com/watch?v=VsCq353sy14

Before Surgery

Medication - DISCONTINUE all NSAIDs {carprofen and rimadyl are the most common) 3 days prior to surgery. If your pet is on medications for any other reason please contact our office to receive special instructions. If you are unsure, please ask and we will be happy to let you know.

Bath your pet - After surgery your pet will not be able to get wet for approximately two weeks until their sutures have been removed and the incision has completely healed. We encourage bathing your pet before surgery if you would like.

Fasting - It is important that your pet's stomach is empty before an anesthetic procedure as the drugs can cause vomiting and lead to severe complications during surgery recovery. Please do not feed your pet after 6 am the morning of surgery. Your pet may receive a small meal, about 1/4 their normal amount, before 6 am. They may also have water. If your pet accidentally consumes food after 6 am, please let us know.

Blood Tests - Prior to anesthesia a veterinarian will perform a complete physical examination to identify any existing medical conditions that could complicate the procedure and compromise the health of your pet. Pre-anesthetic blood work is required prior to any orthopedic procedure. This blood work will assess the functions of the liver and kidneys, as well as check the red and white blood cell counts, electrolytes, blood glucose, and serum protein levels. This information is important to assess your pets overall health. Based on the results we can create a personalized treatment plan for your pet.

The Day of Surgery

On the day of surgery, we require your pet to be admitted to the clinic between 7 am and 8 am. This admission process will take a few minutes as you will be asked questions about your animal's health and you will also be required to sign a surgery consent form if you haven't done so already. This form can be found at our website under "Client Center" and "Online forms."

Fees

All fees and costs must be paid on the day of surgery before your pet is discharged and a deposit may be required before the procedure.

Pet Pick Up

When you pick your pet up they may be tired and groggy. As such, it is important that they are transported home by vehicle and are not expected to walk there. Once at home they need to be kept confined in a warm, quiet, place to recover and relax.

Patient Discharge

When your pet is discharged you will receive discharge instructions from one of our veterinary nurses. Please feel free to ask any questions during the discharge consultation. The nurse will book two follow-up appointments to check on your pet's wound and remove bandages and sutures.

The first recheck will be in 2- 3 days for the bandage removal. The bandage placed on your pet's leg is to help with swelling and bleeding from the surgery. As the swelling goes down the bandage may slip. If this occurs, we recommend bringing your pet into our clinic for a bandage removal. We will check the incision for swelling and bleeding at this time. If there is more swelling than usual at this time or the doctor has other concerns he may recommend we add a second bandage. There will be an additional charge for this bandage of between $45-$55. It is important to keep the elizabethan collar on your pet at all times. The second recheck appointment occurs 12-14 days after surgery. We will remove any sutures and staples at this time. If you get home and you have any concerns please don't hesitate to get in touch. If the veterinarian has prescribed any medications for your pet the nurse will give them to you at the discharge appointment and explain how to give them to your pet and when.

Rover will go home with a bandage:

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, however there is a cost for a bandage replacement if needed. An appointment is required~

The following will be the Physical Therapy regime you can expect once you pick up Rover

If you would like to visit a physical therapy specialist, we recommend Salt Lake Animal Physical Therapy or Alta Dog Rehabilitation.

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 than 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 begin touching their toe down to the floor 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 any time 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.

**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 the foot with the other. Slowly push the foot up into flexion of the 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 the 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 he/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 that 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 than 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.

https://www.youtube.com/watch?v=VsCq353sy14 - Have Rover lie on his/her good side. Apply a warm compress to the 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 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 placed on the hind limb. 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 time and distance.

Stair work - It is ONLY AT THIS TIME after cruciate repair surgery that climbing stairs is allowed. Be sure to provide support 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 for 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 PAIN MANAGEMENT

Pain medications usually are given for approximately 2 weeks after surgery while other dogs may require long term pain management. This will vary depending on Rover's individual needs. It is not uncommon for patient's to develope osteoarthritis {OA) over time after a TPLO surgery. Historically we have recommended continuing oral pain medications long term to help keep your pet comfortable as OA progresses. While this is still an option, we have a new OA pain managment therapy available that doesn't involve at home medicating. Recently, the FDA has approved the first and only monthly injectable anti-nerve growth factor {NGF) monoclonal antibody {mAb) therapy for dogs with osteoarthritis {OA) pain. It's called Librela and we have seen amazing success in our patients. Please ask us if you would like more information or visit www.https://www.librelavetteam.com/.

NUTRITION

All patients should be fed a complete and balanced diet. No specific additions are required, but some clients may elect to add certain supplements, such as glucosamine and chondroitin sulfate. These supplements are intended not to aid healing but rather to prevent or slow the effects of osteoarthritis. Because recovery often results in a significant decrease in activity level, some patients may benefit from dietary restriction as well. Typically, a 10% to 20% decrease in calories is adequate to avoid weight gain during recovery. This is particularly important for overweight and obese patients. Increased weight exerts more stress on implants and is an additional hurdle to recovery. Once activity level is restored, the diet can return to normal. Obese patients may require additional visits to the clinic to determine the appropriate diet plan for recovery and beyond. If weight loss cannot be achieved with reduced calories, a prescription diet may be warranted.

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. We have listed several rehab clinics in the valley for references We are not associated with any of these clinics and recommend you do your research to find the right option for you and your pet.

Alta Dog Rehabilitation 7107 400 W #8, Midvale, UT 84047 (385) 226-5971(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