Help! My dog has a torn ACL!

[aggle-rithm]

My dog Mallory is having surgery next week to repair a partially torn cranial cruciate ligament (the equivalent to an ACL in humans). She's a border collie, so she kind of needs her knee. However, we are opting for the simpler graft surgery as opposed to the TPLO, which is normally done on high-performance dogs, because her temperament limits her to moderate activities.

My wife has been asking on a dog forum about how to support her nutritionally, post-operatively, and wants to cross-check the answers with people who may be a little more knowledgeable than those that recommend, say, homeopathy.

Someone (an ND...Naturopathic Doctor?) told her she should use a homeopathic arnica preparation...however, what I've seen is 4% arnica, so not really homeopathy. (The ND said we should use 200C, which is basically a sugar pill, unless I'm mistaken.)

Anyone have any thoughts on this?

[aggle-rithm]

Here's Mallory:

http://forums.randi.org/imagehosting/514647c0f615ec4d6.jpg

[biostudent]

I would ask the vet. I mean, you're going to be paying a ton of money for this, right? They had darn well better be willing to give you some advice.

I would never trust anyone who offers homeopathic advice.

Beautiful puppy, BTW.

[X]

Partially torn?

One of our dogs did that back in September of 2007.
We initially thought it was a fully torn ACL (well, the canine equivalent thereof), but when the vet did a full check (which involved anaesthesia for the dog), we learned it was only partially torn.

Since it was only a partial tear, the vet told us that we didn't necessarily need surgery (which was a multi-thousand dollar relief), but instead had to keep her from moving for 2 weeks.

So for two weeks, Jade (11 year-old Jack Russel cross) was confined to her kennel, and had to be carried outside to relieve herself, and carried anywhere else if we took her out of her kennel. She wasn't thrilled, but it seems to have worked. She can put weight on her leg again, at any rate.

I'd suggest checking with your vet. It could be adifferent sort or severity of tear, of a difference in dog sizes necessitating surgery for your dog, but you never know.

[aggle-rithm]

;3466394']Partially torn?

One of our dogs did that back in September of 2007.
We initially thought it was a fully torn ACL (well, the canine equivalent thereof), but when the vet did a full check (which involved anaesthesia for the dog), we learned it was only partially torn.

Since it was only a partial tear, the vet told us that we didn't necessarily need surgery (which was a multi-thousand dollar relief), but instead had to keep her from moving for 2 weeks.

So for two weeks, Jade (11 year-old Jack Russel cross) was confined to her kennel, and had to be carried outside to relieve herself, and carried anywhere else if we took her out of her kennel. She wasn't thrilled, but it seems to have worked. She can put weight on her leg again, at any rate.


The weight of the dog makes a lot of difference. According to the literature I've read, the cutoff point is 20 pounds for conservative management vs. surgery. Ours is over 40 pounds.


I'd suggest checking with your vet. It could be adifferent sort or severity of tear, of a difference in dog sizes necessitating surgery for your dog, but you never know.


The surgeon won't be available for questions until the day of the surgery. Also, a lot of vets (from what I hear) don't necessarily know much about nutrition. (My wife tells me that a vet she's talked to said they only got 8 hours of nutrition training in vet school, and it was sponsored by a pet food company.)

[aggle-rithm]

I would ask the vet. I mean, you're going to be paying a ton of money for this, right? They had darn well better be willing to give you some advice.

I would never trust anyone who offers homeopathic advice.


I got in trouble with my wife today in the pharmacy, as we were looking at the homeopathic snake oil, for saying too loudly, "they're just sugar pills! Don't waste any money on this crap!"


Beautiful puppy, BTW.

Yes, she is! A deceptively angelic countenance.

[Badly Shaved Monkey]

I think it is clear. Keep the dog. Lose the wife. :)

But, to be serious for a moment.

There are various surgical options and conservative treatment may be adequate in some cases. There is a big difference between the acutely traumatically damaged ligament and the ACL that has chronically degraded. There are a great many factors involved and much of the discussion is dependent on the exact clinical circumstances of the individual patient and the owners attitudes to surgery and costs. I would not presume to comment on a case that I have not personally assessed.

Comments about vets' paucity of nutritional education general come from sources that have a very distinct agenda to push. You may get a lot of very definitive opinion about what you "must" do to aid recovery using nutrition. I would be astonished if the strength of that opinion was matched by the strength of any evidence to support it.

As far as we can know homeopathy is a complete waste of time in all circumstances. It is a waste of money, but more importantly may serve to distract from what is really going on. I don't have an opinion on arnica as a herbal ingredient in real pharmaceutical amounts, but I would not be keen on anything that involved sticking stuff on a dog's skin near a surgical site.

[El Greco]

Arnica is supposed to be a mild anti-inflammatory, but it does nothing. Not even mild.

[Haywire]

My dog Gus had the TPLO surgery last November. Her weight had a lot to do with it. Before the surgery she was pushing 90 pounds, now she's around 80. The vet said, "One cup of dog food a day." The day of her diagnosis was a lot worse for me emotionally. I didn't want people to think that I was a bad doggy daddy. She started limping the end of October, and I thought it was just her arthritis, which she's had problems with two years ago. Arthritis would have been cheaper.
For her surgery they had to shave her entire left rear leg, and a square on her spine for the epidural. The hair is still growing back, and the vet said it will take about a year to grow back completely. It's a great conversation starter.
Get better Mallory!

[Rolfe]

I was going to type something, but BSM said it.

BTW, BSM, we've got a new live homoeopath in General Scepticism. She's citing Day, among others. Happy times!

Rolfe.

[Mojo]

My dog Mallory is having surgery next week to repair a partially torn cranial cruciate ligament (the equivalent to an ACL in humans). She's a border collie, so she kind of needs her knee.


Cranial? Knee? :confused:

[Badly Shaved Monkey]

Cranial? Knee? :confused:

Cranial (vs caudal) is a direction, meaning headwards (vs tailwards). Humans stand up on their back legs so standard human nomenclature is actually rather a special case, so we have anterior/posterior for front/back and superior/inferior for up/down. Other species are standardised with cranial/caudal for front/back and dorsal/ventral for up/down.

"knee" is not used properly in animals but is used casually for "stifle". Both refer to the femorotibial joint.

[Badly Shaved Monkey]

To be complete, in the distal limb (past the carpus or tarsus) you should use dorsal/palmar or dorsal/plantar. Within the head, cranial becomes meaningless so you have rostral caudal and inside the mouth me are supposed to use dentist's terminology but most of us can't be bothered with mesial and distal all having special meanings in the mouth.

[Mojo]

Thanks.

[coops]

My dog Jessie (a boxer/mastiff x) tore her major cruciat ligament mid last year while chasing a rabbit.

Like others have said, her weight was a major contributing factor. (she was 42kg, now down to a healthy 35kg).

After the surgery we had to keep Jessie confined in a cage for about 4 months to prevent her putting pressure on the joint.

She now walks with a slight limp and isn't allowed to go for runs or play with other dogs for long but at least she can walk without any pain.

Medication wise, we give Jessie a standard fishoil capsule with her meals as well as a joint guard powder from the Vet. This is meant to help strenghten her joints to prevent another accident and to also lessen her arthritis.

If you want any specific information about the surgery itself or anything else just let me know and I'll go through Jessie's records for you.

[aggle-rithm]

Comments about vets' paucity of nutritional education general come from sources that have a very distinct agenda to push.

My wife frequents dog forums, and says this is a VERY divisive issue...I'm happy to stay out of it.

[aggle-rithm]

Thanks for everybody's comments. One of the other things we were wondering about was what lengths we should go to for doggy ergonomics, post-op. We want to avoid having her go up and down steps, but there is some confusion about what constitutes a "step". If it's a two- or three-inch drop, is it a step, or can it be considered a level surface for all intents and purposes?

FYI, I'm asking more questions than usual because my wife is standing over my shoulder, telling me what to type. She found the "lose the wife, keep the dog" comment especially helpful. ;)

[Badly Shaved Monkey]

She found the "lose the wife, keep the dog" comment especially helpful. ;)

Well, Mallory is a really pretty dog, so your wife can hardly blame me.

[aggle-rithm]

My dog Gus had the TPLO surgery last November. Her weight had a lot to do with it. Before the surgery she was pushing 90 pounds, now she's around 80. The vet said, "One cup of dog food a day." The day of her diagnosis was a lot worse for me emotionally. I didn't want people to think that I was a bad doggy daddy. She started limping the end of October, and I thought it was just her arthritis, which she's had problems with two years ago. Arthritis would have been cheaper.
For her surgery they had to shave her entire left rear leg, and a square on her spine for the epidural. The hair is still growing back, and the vet said it will take about a year to grow back completely. It's a great conversation starter.
Get better Mallory!

Ironically, I think WE were the cause of Mallory's injury. Like a lot of high-drive dogs, she likes to jump up on people and "tag" them. We tried various methods to discourage this, and ended up with a behavior where she starts to jump up on us, then thinks better of it in mid-maneuver and twists to the side at the last minute.

This twisting motion while jumping is very likely what caused the injury. :(

[X]

In my case, the vet said it could be caused by
- jumping/large steps
- running/activity
- being run over by a larger dog

In our case, we have all three happen often.

[Badly Shaved Monkey]

;3468057']In my case, the vet said it could be caused by
- jumping/large steps
- running/activity
- being run over by a larger dog

In our case, we have all three happen often.

For acute primary injuries, yes.

The majority of cruciate injuries are the result of chronic degeneration, which probably results from abnormal loading in dogs with excessively straight hind legs.

[Haywire]

Gus isn't really a high-energy dog, just a high-milage one. I think the injury happened when she was walking on the side of a small hill. She just did a little stumble motion, and that was it.
For three days after the surgery, her left leg was wrapped up in a Ace bandage. Since I live on the second floor, I had to use a large bath towel like a sling across her middle to help her up and down the stairs. After she go the bandage off, she didn't need any help with stairs. I just keep a close eye on where she's going, she doesn't need to go off any steep drops.

[Badly Shaved Monkey]

Gus isn't really a high-energy dog, just a high-milage one. I think the injury happened when she was walking on the side of a small hill. She just did a little stumble motion, and that was it.
For three days after the surgery, her left leg was wrapped up in a Ace bandage. Since I live on the second floor, I had to use a large bath towel like a sling across her middle to help her up and down the stairs. After she go the bandage off, she didn't need any help with stairs. I just keep a close eye on where she's going, she doesn't need to go off any steep drops.

That would be typical of the chronic degenerative version where the final instability arises from an apparently trivial incident.

[Haywire]

There's a 40% chance she'll need to get the other knee done.

[aggle-rithm]

There's a 40% chance she'll need to get the other knee done.

There's a 100% chance that I didn't want to hear that.

[aggle-rithm]

We got Mall-o-dog back from the vet yesterday. She's limping around on three legs, of course, and would lick her staples clean off if we didn't keep an Elizabethan collar on her.

We have to give her four pills a day. No fun.

Now I'm wishing we went with the homeopathic remedy. That way, it wouldn't matter whether she actually swallowed it or not.

[biostudent]

Awww, poor thing. I hope she gets well soon.

[bethanythemartian]

I feel for you dog, she's so pretty looking. Reminds me of my long lost doggy...

I did find your comment about not giving her the homeopathic remedy funny, but I also have a pill hint.

We had a very large dog (he's my momma's doggy, and lives with her now) whose name was Beron, and for a while he had a mosquito-borne illness. He quit eating altogether, and lost 20 pounds.

We tried vienna sausages to get him to take the pills, and that worked. Then he figured that trick out. *Sigh* okay, so... we hid them in another kind of food... something sweet. I don't remember what it was that we used, but it worked about as well. He figured it out, and would spit the pill out.

Then we stuck the pills in a little bit of velveeta. He couldn't separate the pill from velveeta, and he finally started eating the pills and gaining weight regularly (this was a 'he will die if he doesn't take these pills and start eating' problem). I'm sure it's not a vet recommended trick, but I thought I'd share that. (We didn't use much, just enough to coat the pill.)

I'm sure another processed cheese would work, and I know they have pill pockets in the pet stores, and I'm sure there's many other ways to get your doggy to take pills, but velveeta is so thick and sticky that they can't separate the pill from the 'good stuff'.

Hope your baby gets better soon.

[Lilith]

My dog had TPLO surgery in 2001. She's about 11 years old now, and the surgery was a success, it seems. She and I didn't meet until 2003. Her surgery was paid for by Pets in Need in Redwood City, CA, as they obtained her from the Humane Society and then found out she had a problem with her leg. Pets in need paid about $2,400 for her surgery and meds - and then kept her for months at their center, and followed a strict rehab schedule. I only learned this because my vet in CA gave me a copy of her records. If anyone out there is looking for a charity to give money to, this place sure does deserve some!

Anyway - just wanted to let you know that it was successful, but expensive. She weighs about 60 lbs and is an active dog.

I interpretted cranial as "of the cranium", which confused me in the OPs reference to the cranial cruciate ligament! :) I would opt for "rostral" instead, but cranial makes sense, too.

[Vic Vega]

You're lucky she doesn't need Tommy John surgery. That would keep her out until next season.

[Badly Shaved Monkey]

I interpretted cranial as "of the cranium", which confused me in the OPs reference to the cranial cruciate ligament! :) I would opt for "rostral" instead, but cranial makes sense, too.

Rostral would not really be a better anatomical term elsewhere than the skull because of its derivation. Rostral \Ros"tral\, a. [L. rostralis, fr. rostrum a beak; cf. F. rostral.] http://dictionary.die.net/rostral

[Haywire]

There's a 100% chance that I didn't want to hear that.

No, no, no, my dog, Gus. Sorry about the confusion.:o

The day she got her Ace wrap off, she also got her own Elizabethan collar. On the way home, I was feeling pretty sad for us both. She looked like a clown-dog, and I owned a clown-dog. I rolled down her window so she could get some air, and she stuck her head out, collar and all. The wind blew her head around a little bit more than I think she expected. That cheered me up a bit.
Cheese and dog medicine, a great mix.

[Lilith]

Rostral would not really be a better anatomical term elsewhere than the skull because of its derivation. Rostral \Ros"tral\, a. [L. rostralis, fr. rostrum a beak; cf. F. rostral.] http://dictionary.die.net/rostral

Yep. I learned "rostral-nostril" to remember the direction. And since most of my anatomy training pertains to things in the skull, I hadn't considered that the general rostral direction might need a new term away from the head. I love learning new things!

[aggle-rithm]

Awww, poor thing. I hope she gets well soon.

She's starting to get back to her old, precocious self. She figured out yesterday that, since she's not allowed to lick the staples, she can roll onto her side and rub her leg on the grass when we take her outside.

She's also learned that the Elizabethan collar makes a handy tool to torment the cats. She just runs up to a cat and scoops them up.

The cats are not thrilled with this development.

[Rolfe]

I'm just a poor struggling pathology type, but I thought "Anterior Cruciate Ligament" kind of said it all?

Rolfe.

[Dogdoctor]

Sorry I am late to this thread. It is difficult to determine the best treatment for an anterior cruciate ligament tear for several reasons. One problem is no one (almost no one) does randomized controlled studies on this problem. You have to look at short term and long term outcomes. Some procedures such as TPLO seem to be good short term except have possible more serious side effects than other procedures. Long term all joints undergo degeneration. There are new non steroidal anti-inflammatories that are better than aspirin. Physical therapy can make a big difference in the outcome of surgeries for this problem. As far as nutrition goes there isn't enough scientific information about most nutrition and most diseases to say anything meaningful about it. Fish oil has anti-inflammatory actions however does that make any difference in the course of the disease? (unknown) Lastly some dogs will do well enough without surgery so you need to have randomized controls to say something more meaningful.

[aggle-rithm]

One problem is no one (almost no one) does randomized controlled studies on this problem.

Fortunately, this thread is a gold mine of anecdotal evidence! ;)

[Dogdoctor]

Unfortunately the disease does not lend itself to good quality studies. No one wants their pet to be the control.

[aggle-rithm]

Well, Mallie was making great progress until yesterday morning, when she suddenly came up lame. She won't put any weight on the leg at all.

Then yesterday, my wife noticed that her leg was starting to swell and was warm to the touch.

This morning, the suture wound started to ooze pus.

She is back at the vet's. Still waiting for word on what's gone wrong.

[Rolfe]

Erk. I think we get the basic idea.

It takes two days to get a sensitivity report though.

Rolfe.

[Dogdoctor]

Bummer. It seems most likely to be a post op infection.

[aggle-rithm]

OK, the vet says the infection is superficial and is going to send her home with antibiotics. They removed a couple of the staples to let it drain. I'm crossing my fingers hoping that the surgical repair hasn't failed.

Her leg apparently itches something crazy. She has figured out how to scratch it using the edge of the E-collar. She hasn't managed to get to the wound itself, but has rubbed the skin raw just next to it.

The most troubling thing is her reluctance to move more than a couple of inches. I don't think she was stayed still for this long since she was a zygote.

On the other hand, she has a healthy appetite, as always.

[aggle-rithm]

Mal-Dog (from henceforth to be known as The Great Mal-dini) managed to circumvent her E-collar by stretching just right and bending the plastic. The vet techs were astonished. They fashioned her a new, ludicrously huge E-collar that she (supposedly) can't defeat:

http://forums.randi.org/imagehosting/514647cfea59b9f61.jpg

She's doing better now. Starting to put weight on her leg again.