TPLO Surgery: My personal insights and a conversation with Top Dog Health’s Dr. James St. Clair
Read to the end for a VIDEO: Booker’s first time on the underwater treadmill
May 27th 2015 was a day I had been dreading for weeks. My worst nightmare with our working shepherd, Booker, had come true. He had a torn ACL (anterior cruciate ligament) and May 27th was the day he would have surgery.
Unfortunately, torn ACL’s are very common in dogs. The ACL ligament helps to stabilize the knee. Active dogs, sedentary or overweight dogs, and dogs who were spayed or neutered before puberty are all at increased risk for ACL injury. If you think that sounds like a large population of dogs, you would be correct. It’s also a known fact a high percentage of dogs (somewhere between 30-60%, depending on the study) that tear one ACL will tear the ACL in their other leg within two years of the initial injury. Ouch.
Being trainers, we knew that Booker’s crazy activity level and his job as a working demo dog put him at risk, so it wasn’t a surprise when he came up lame. A torn ACL was on the very short list of things we thought it might be. But we also knew it was a long road to recovery.
I’ve never had a dog with a torn cruciate, but I had known several of our good clients, family, and even friends who had had dogs with the injury, so I started to do my research. I wanted the very best for Booker, and my first instinct was to educate myself the best I could. One of the most complete resources I found online was absolutely free. It was TopDogHealth.com, run by a veterinarian, Dr. James St. Clair who has dedicated his professional life to helping dogs recover fully from the type of injury that Booker presented with, and avoid further injury. I signed up for his newsletter and promptly printed out a long, detailed guide to TPLO recovery. I was so impressed with the guide, and the generosity of the resource, that I contacted Dr. J (as he prefers to be called) and asked if I might interview him for this blog post. He said ‘yes’ without hesitation, and spent well over an hour on the phone with me.
There are many different types of surgeries and treatments to deal with a torn ACL. If you are facing this injury and resulting decisions, a qualified veterinarian can help you decide which type of surgery is best for your dog, your situation, and your budget.
We had consultations with three different doctors, all of whom were recommended to us and seemed like excellent choices. In the end, we opted for a type of surgery called a TPLO (Tibial Plateau Leveling Osteotomy). This type of surgery required the bone to be broken, reshaped and screwed into place. This makes repairing the ACL unnecessary, as the quadriceps muscle gives stability to the knee. If you want a more detailed understanding of this surgery, click here.
Keeping your dog quiet for the first eight weeks is critical in the recovery process, because the dog is basically healing from a broken leg.
But the next eight weeks and beyond are also important. Arguably AS important. Why?
If a human being had a leg injury of this kind, you know what would happen. Surgery, yes. Then what? Physical therapy. And finally, a long progression of work that eventually leads back to full activity. Limited walking, slow walking, normal walking, short jog, longer jog, and then, and only then, back to a full run or quick sprint any old time you feel like it.
Most dogs will start walking on their surgery leg quite soon, within days or a week. It gets progressively better from there, and by 4-5 weeks post-op, Book was less lame on his surgery leg than he had been prior to surgery. But he was far, far from truly recovered.
Try explaining that to a high drive working Shepherd who gets antsy if he takes a weekend off. This was the primary reason I was so, so dreading the day Book would have his surgery. Any pretense of his ‘normal’ was about to go straight out the window and right into the proverbial dog house.
In fact, the physical therapy is the key to a full recovery. You can have the best surgeon in the country do an ACL repair on your dog and have it go beautifully, only to have your dog require another ACL repair in the next year, or worse, have the initial surgery break down altogether and have to have a ‘do-over.’
You absolutely can’t depend on your dog to ‘let you know’ when they are ready to run and get back to a routine. They are staunch and they don’t understand what’s going on. If I had let him, Booker would’ve been running around for weeks now. And that would’ve ruined his chance of running and chasing his toys for years to come. I couldn’t do that to him, regardless of the imposition of keeping him leashed, quiet and under control 24/7 for months.
We’re lucky in our area, we have a full on animal rehabilitation and physical therapy office in Rochester Hills, literally around the corner from our dog training facility. We also have some excellent surgeons in Metro Detroit.
When I asked Dr. J of Top Dog Health what was the single most important thing someone can do to make sure their dog makes a full recovery from a TPLO, his response, without hesitation, was ‘find a qualified canine rehabilitation center in your area.’ He also said empowering yourself, learning as much as you can about helping your dog recover is critical to the success of the surgery. You are your dog’s best advocate.
I followed aftercare instructions of the surgeon we chose, Dr. Daniel Degner in Burton, Michigan, and Dr. J’s TPLO guide (the guidance was similar) to the very best of my ability. This meant several things. Booker was always, always on a leash, except when in a crate. He slept in a crate, which he hadn’t done for years. Booker and I had a 3-4 times per day 20-25 minute appointment during the first two weeks. Some combination of heat, passive range of motion exercises, and icing. Using a sling to navigate the two stairs to get outside to relieve himself. Walking him around the yard on a leash. No jumping. No jumping. NO jumping! (I probably repeated this in my sleep.)
After Book’s two week checkup, and Dr. Degner said Book’s progress was excellent, we were cleared for three times daily 5 minute walks, working up to 10-15 minutes and physical therapy. We had done a pre-surgery consultation and exam with Dr. Kern at Pawsitive Steps Rehabilitation in Rochester Hills, and so we began our regiment of twice weekly therapy sessions. Those sessions consisted of adding specific exercises, walking on an underwater treadmill, stretching, and laser therapy. Each therapy session was about an hour and a half.
If you’re starting to add up the amount of time being put into Book’s rehab, you’re probably coming up with close to an hour each day, spread throughout the day. And that’s not on days we go to Pawsitive Steps. As Dr. J says, ‘you have to become your dog’s personal trainer.’ That, and he also told me to view all this time spent as an investment.
Yes, this is an investment. I couldn’t imagine doing any less for any of my dogs, but especially for the dog that has been an integral piece of building our Sit Means Sit brand. A dog who has worked for nearly six years inside our business, helped hundreds of dogs and people, been the best ambassador we could ask for. An investment, and a no-brainer, but not without sacrifice.
Booker is now six weeks post-op. So, back to all that dread I had in the beginning. I won’t lie and say this has thus far been an easy process. It hasn’t, and I’m very glad I researched and had a decent understanding of the resources available to me. Rehab is time consuming, but it is very doable. The exercises are simple to do at home, and there are great professionals online and locally who can help you. Patience is key.
Dr. J has not only his guides online (for free!) he also has a high quality line of Glucosamine products, which I decided to use on Booker as well. I did this before even interviewing Dr. J, when I read the independent reviews of clients on Amazon. Dr. J did have some advice on choosing a joint supplement, his or anyone else’s.
- Look up independent reviews, anyone can write a testimonial on their website.
- Call the company. Ask where their products are sourced. Obviously, not everything that comes from China is bad, but quality controls standards in the US are much stricter.
- Buyer beware. The NASC (National Animal Supplement Council) only makes sure the label has what it says, nothing about the raw materials or the science backing the product.
Finally, Top Dog Health also has a whole series of videos, in case you’re reading this in an area where animal PT isn’t available.
Empower yourself. Learn how to best help your dog, if for no other reason than to avoid having to do it all over again on the other leg.
**Also be on the lookout for Dr. J’s new book, ‘Dogs Don’t Cry: 12 signs of pain in your dog’