Post-TPLO–Day 56: A New Rehab Routine

Well, today is the 8-week mark we’ve been waiting for. The day that, maybe, Carlin could return to something of a careful, but more normal life. But, it turns out, it’s going to go slower than I hoped. Still no stairs, no jumping on the bed, no running, no playing with Grits. Sigh.

Where we’re starting now is with two things:

• An elimination of the pain medicine
• Additions to his rehab routine

Carlin has been taking 400 mg Gabapentin, 2 times per day for about 6 weeks now. Before that, he was on that amount 3 times per day. But today the rehab vet suggested we stop the drug, and watch him closely to see if there are any signs of pain. Like what?, I asked.

Well like, hunching his back, or being less willing to walk or do his exercises, or vocalizing pain, or starting to limp again, or refusing to participate in anything, loss of appetite, looking depressed. The rehab vet wants us to watch him for the next couple of days until his next appointment on Thursday, and then report back. If it looks like he has discomfort, then we’ll go back on the Gabapentin.

At the same time, she’s adding a couple of exercises. One is slow walking over some cavaletti poles that are spaced about 2 feet apart and, at least for right now, only about 2 inches off the ground. I understand that these exercises are good for improving balance and strength. They also get the dog to pick up their legs and move their leg joints differently that they would move with just regular walking. This all makes the workout more comprehensive.

The other is doing very tight figure 8s around posts. The posts are positioned only about 4 feet apart. This is to get him to bend his spine while walking. They also help with the sense of balance as well as help strengthen the muscles that maintain balance. Like the cavalettis, this exercise also helps the dog feel where their body is in space.

Of course, both of these exercises are taught with string cheese lures. The rehab visits also still include the cold laser and the PEMF therapy, and for those, he’s persuaded to stay on the mat using a peanut-butter-filled lick mat.

At home were still doing the passive-range-of-motion knee flexing exercises, icing, back stretching, and moving his hips side to side. Now we’re adding the cavalettis (as soon as the equipement arrives) and the figure 8s.

Carlin loves the rehab vet. Who wouldn’t, when apparently endliess string cheese and peanut butter are involved. And this is a very good thing, seeing as how it’s going to go on for months yet.

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Post-TPLO—Day 47: Peanut Butter to the Rescue

When your vet tells you about surgery for your dog, they talk about why your dog needs it, how it will fix the problem, a bit about how it’s done, which medications you’ll need to give, and, possibly, what rehabilitation your dog will need. All very factual.

What they don’t tell you about is whether and how the aftermath will change your life.

Carlin’s surgeon recommended no rehabilitation, no physical therapy. All they wanted us to do was do strict crate rest with potty breaks for three weeks, and then daily leash walks starting at 5 minutes per day and then increasing my one minute per day. That’s it. And that sounded kind of easy.

But no rehab just didn’t accord with my own experience with joint surgery. I got my full range of motion back because I had physical therapy. And I have a performance dog who badly wants to get back to work. So, despite what the surgeon said, we started therapy just over a week ago with a veterinarian who specializes in rehab.

All well and good. But going to physical therapy comes with homework. We have to do several exercises with Carlin twice a day. It’s been time-sucking challenge. In large part because Carlin has really, really disliked it.

I think the first exercise in the series is the worst. It’s called PROM, or passive range of motion. Basically, we want to make sure the knee returns to full flexibility. So we start by getting Carlin lying on his side, and then, keeping the knee joint touching his body, gently pull his hock (like a person’s heel) up toward the base of his tail as far as it will easily go. We hold the knee in the flexed position for 5 seconds, let go, and then do the next one, for 10 repetitions. On each knee.

The first several days, he made this whine/growl noise when we tried it. We got maybe two repetitions on each leg. The rehab vet said it was fine to stop when Carlin complained, and then just try it again next time. After several days, we did get up to 10 reps each leg without too much complaining on most (but not all) sessions. But there was still with a lot of squirming and attempts to get up or away… It was just hard. And it made me cry in frustration. Maybe this is why the surgeon didn’t recommend rehab.

Rehab is, as I know from my own experience, not easy and very often uncomfortable. So I understood where Carlin was coming from. Totally. So the question: How to make this all tolerable for Carlin, and thus for ourselves as well.

We tried to keep him occupied with peanut butter on a lick mat, but that was so so so messy. Peanut butter everywhere. All over Carlin, on my legs and shoes, on the mat, everywhere. Then Russ had a brainstorm—what about peanut butter in a kong?

That, finally, worked. We get Carlin one his side, on the orthopedic bed, and give him a peanut butter kong. We’re still very gentle, feeling for that angle that is just enough flexed but not too much. But today, we started getting 10 reps on each side, with no complaining and no trying to get away, all because of that blessed kong.

We let him keep the kong through the icing that follows, 10 minutes per knee. And then he does a “front limbs on a low box” stretch, and then another exercise where we shift the weight side to side from one rear leg to the other. We do these two exercises luring him with string cheese.

And then it’s back to the 10 more reps of the PROM on each leg, and another peanut butter kong.

(For those who are curious, I estimate that he gets about 2 Tbs of peanut butter in each session. I stuff it way down in and along the inside walls so that he really has to work to get at it.)

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Post-TPLO—Day 37: Starting Rehab

I’m not sure what part of our first rehab appointment Carlin enjoyed most: the peanut butter-filled lick mat or the acupuncture.

The lick mat definitely kept him focused and busy while the vet techs were using the cold laser wand. And the string cheese kept his attention while they were showing me how to do some passive range of motion exercises on Carlin’s knees and a weight-shifting exercise for his hips.

But the acupuncture? I know some folks who think that acupuncture is all placebo—you think it’s going to make you better, so it does, or, at least, it feels like it does. But for a placebo to work, the patient has to know that he’s getting some treatment and have some faith in it. But a dog?

Carlin had no idea that a treatment was coming, and since this was his first experience with acupuncture, faith didn’t, couldn’t, really play a part. But as soon as the vet placed the first needle, Carlin’s body visibly relaxed. His face softened. His usual hyper-aware notice of the world around him shifted and almost kind of went inward. It was like it had taken a deep breath and let it out slowly. Like he had sunk feet deep down into the soft support of the dog bed. He allowed Dr. LeFave and the tech to pet him, gave them licks in return, and then put his head down and zoned out.

I’ve had acupuncture for myself. One time, the practitioner said he could help my very painful achilles tendon in 12 sessions. It took only 10. And it was a miracle. I’d fallen down some stairs and tore the tendon. I tried a whole raft of failed physical therapy, spent fruitless months in a boot, wasted time doing the whole rest/ice/elevation thing, and got frequent massages that felt good in the moment but didn’t help over the long term. Then several months later, after I’d cried my way through what was supposed to be a fun weekend trip, my massage therapist suggested acupuncture. And that worked, to my immense relief and gratitude. I’d about given up ever walking comfortably again.

Later I tried acupuncture for frozen shoulder. Same acupuncturist, but this time, he wasn’t sure he could help me, but he’d try. It didn’t work. At all. Didn’t relieve the pain or help me get back any range of motion. I had to have surgery.

I also got acupuncture for my first IWS, Cooper. We tried it to help his sore back, and that helped a bit. We tried it to see if it would help his SLO, but we didn’t see any improvement. So, with Carlin, I thought, maybe it’ll help, but maybe not. And I don’t know if acupuncture will help him over the long term. But, today, it sure helped him to be calm and happy. And for that, I am grateful.

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