Brighter days ahead, Lira at 11 weeks post procedure
The last four months have been very challenging between dealing with the winter COVID-19 surge, a pretty rough winter in Seattle and Lira’s knee injury. It is almost 4 months to the day that we got the diagnosis of a torn CCL in Lira’s right knee and had to seriously restrict her activity to try an heal it up.
After a few weeks rest she was looking much better and for the most part had stopped limping but I knew from research that this was to be expected and that we had a long ways to go. We began investigating options to deal with the tear and it came down to three approaches:
- TPLO Surgery – this is the standard procedure for pretty much any suspected tear and we did consult with a surgeon who recommended we go that route. The surgery is pretty successful when it goes off without a hitch but the complication rate runs between 5-30% depending on who you believe and complications can be so bad that they lead to amputation or a euthanized dog. The good news with it is that the dog is back up and running in about 12 weeks and while the recovery is tough it is helped by the implants in the leg that help hold things in place.
- Conservative Management (CM) – this approach just rests the dog and relies on building of scar tissue to replace the torn ligament. Braces can be used to help the dog walk and get some exercise w/o reinjuring the knee. This is a challenging approach since it takes 9-12 months minimum to build the scar tissue and have it “harden” enough to give sufficient stability and it seems that setbacks can be numerous along the way extending the time even further. There is a great and supportive Facebook Group for this approach.
- Stem Cell/PRP – as we were talking surgery with a friend they mentioned another mutual friend who did stem cell treatment for her shoulder so I started investigating stem cells. Sure enough, the Veterinary Orthopedic Sports Medicine (VOSM) group out of Annapolis had developed a procedure for competitive sporting dogs that uses stem cell and platelet rich plasma (PRP) injections to help the dog re-grow the ligament tissue and a typical recovery in 12-16 weeks.
Lira with Posh brace
After finding out about stem cells I found that we had a local vet in Seattle who worked with VOSM and had authored studies with the vets there so we set up an appointment. We didn’t want to do TPLO until January at the earliest so figured we had time to look at this option. In the meantime we ordered Lira a Posh knee brace so she could get outside a bit more with some support and not bo so concerned about her making the knee worse. The brace was a bit of an adventure to get measured for, fitted and to get her used to it but she quickly adapted and figured out that if she let me put the brace on she got to go for a longer walk.
We also started adapting the house for an injured dog since hardwood floors and running to the door or window are not a good thing. We covered most of the hardwood with rugs, yoga mats, etc… and got out all our old puppy gates again so we could create containment zones in the house and limit her ability to go too far and pick up speed. We also swapped out her food for the RedPaw Maintenance X-Series food and cut the amount way down yes she was still gaining weight from lack of activity.
In early December we had the consult with Dr. Alycia Lamb at the Sunset Hill Veterinary & Rehabilitation Center and she felt that Lira probably had slight tears in both knees but also that she was a good candidate for stem cell treatment. The big caveat is that the procedure only works if the tear is <50% of the ligament which we wouldn’t know until they took an actual look at it using a needle scope which was the first step in the procedure. If the tear turned out to be >50% then they would stop after the scope and we’d be back to looking at TPLO or CM.
Recovery after procedure
On December 21st Lira went in for her procedure in the morning. Dr. Lamb said she’d call within an hour or so if they found the tear was too big and if I didn’t hear from her that quickly it meant the tear was small and they’d go ahead and collect bone marrow and blood, convert the marrow to stem cells and the blood to PRP and do injections into both knees. Luckily that first hour came and went and when I got the call we found that Lira had a 15% tear in her right knee and a smaller tear in her left so they went ahead with the whole procedure and we should pick her up around 4-5 that day. About two hours later we got the call saying Lira was up and ready to go home already so we picked her up and brought a fairly groggy dog home.
The first week was tough, she was on opioid pain meds and pretty much slept aside from a few potty breaks outside. By the end of that week we had gotten her off the hard drugs and onto Gabapentin to help sedate her and deal with any residual pain. After two weeks she got to start taking two 5-minute “walks”, started some rehab exercises daily and began weekly laser treatment.
The next six weeks were challenging keeping her calm enough that she didn’t tear her knee more while slowly increasing her activity level by 5 minutes per week. We had a few minor setbacks when she’d get overly excited and jump or pull but they all seemed to resolve themselves pretty quickly. After two weeks we had to increase her sedation with Trazadone and Gabapentin 3x a day which meant Lira slept a lot but wasn’t at risk of making things worse.
In the treadmill
At eight weeks she was up to two 20 minute walks a day and started underwater treadmill once a week on top of laser and daily rehab work. She had a minor setback just before the 8-week follow up exam but Dr. Lamb thought that she was doing pretty well and the knee seemed much more stable so there was still a good chance that the procedure would work. Since then in the past month Lira has been increasing her walks up to two 30-minute walks a day, added in hill climbs and has been spending 30 minutes on the treadmill two days a week, she seems to enjoy her sessions with Tina & Kristen at the clinic each week. In the past week we started cutting back her medication so now she’s taking Gaba/Traz every 12 hours instead of every 8. She also started Dasuquin Advanced at 8 weeks and is still in the “loading” phase with it getting two a day right now.
The 12-week exam will happen at about 12.5 weeks and we’ll see where we go from here. We need to wean her off the drugs the rest of the way, get her to drop the excess weight she gained and keep increasing her morning walk time and we’ll discuss this with Dr. Lamb in a week. She’s looking pretty good, just a bit stiff when she first gets up but once she’s moving you’d never know she was injured and in the last week she’s gotten a bit of spunk back and wants to wrestle some. I’m very nervous about her being off leash again and being around other dogs so these things can wait a while longer. At this point I’m planning on keeping her on leash until just before hunting season and then get her back working with the e-collar to be able to get out and hopefully chase birds again.