PHYSICAL THERAPY REGIME

This is an expert of the physical therapy booklet for Harley's rehab, that I was sent home with. It's published by TopDog Home Therapy Program.

HOMECOMING
THE HOUSE
It is important to have a plan on how and where you are going to restrict or confine your dog during this crucial post-operative period. Quality rest is as important as having a good therapy plan. Many owners incorporate one of the following:
Dog Crate
Gated off Area
Room confinement

NO JUMPING
It is EXTREMELY important not to allow your dog to jump, AT ALL! Over extension of the stifle could compromise the repair
NO JUMPING on/off bed/couch/on you!

NO STAIRS
Stairs, like jumping will overstress the joint and inhibit repair. In the beginning stages, right after surgery, it is imperative that you do what you can to prevent your pet from going up or down stairs.

NO HORSING AROUND
As much as you would like top lay with your dog this is not a good idea.

WALKING SURFACES
Wood floors, tile, linoleum etc can all be very slippery t your pet. Consider putting down some throw rugs with rubber backing to make things easier on your dog.


HOME THERAPY PROGRAM
WEEK BY WEEK PROTOCOL
The following weekly protocol has many benefits. It’s important to follow these guidelines as closely as possible in order to:
Speed recovery
Decrease pain and enhance healing
Prevent further disuse muscle atrophy
Restore normal range of motion
Decrease possibility of further compensatory problems

During all times outside of therapy, STRICT CONFINEMENT IS MANDATORY. It is extremely important to follow this protocol as closely as possible to ensure recovery. Any form of rambunctious activity is PROHIBITED during this critical recovery period.

PERFORM ALL THERAPIES IN THE ORDER DESCRIBED


WEEK 1
1. MASSAGE (5-10 min) (3-4 times a day)
This is best done with your pet lying on his or her side. Start by gently rubbing the affected limb from toes up the leg. If you pet is reluctant to have this done, try using less pressure or try again later.
2. PASSIVE RANGE OF MOTION (PROM) (10 repetitions)( 3-4 times a day)
The goal of PROM is to manually simulate the normal motions of each joint. This is best done after massage and with your pet laying on his side. Starting with the hip, gently extend and flex. Continue on to the knee and ankle. Be sure to support the leg carefully with your other hand while performing these movements. Do not force PROM. If your pet seems uncomfortable, stop and try again later.
3. SHORT AND CONTROLLED LEASH WALKS (5 Min)(3-4 times/day)
These walks should really be for elimination purposes only at first. The slower your dog walks, the more likely they will place the repaired leg down while walking. If needed, use a support harness or towel under the belly to support your dogs hind end.
4. ICE THERAPY (10-15 min, after exercise)
following the above therapy exercises, it is important to apply cold therapy to the affected knee. You can use commercial gel ice packs or even frozen vegetables. For most ice packs, wrap them in a towel or bad before applying.

3 days after surgery you can begin applying MOIST HEAT prior to your therapy session with your dog. DO NOT do this prior to 3 days post op if the swelling around the joint is still significant.


WEEK 2

1. MOIST HEAT (10 Min Prior to exercise)
For this therapy, a commercial moist heat product is advised. Moist heat has been shown to penetrate tissue better then dry heat. Types of moist heat are available in most drug stores. Another way to provide moist heat is to take a wash cloth and wet it with hot water. The heat should be warm enough to touch, but not so hot that it burns you when you are applying it to your dogs joint.
2. MASSAGE (10 MIN)(3-4 TIMES/DAY)
3. PROM (15 REPS)(3-4 TIMES/DAY)
4. SHORT AND CONTROLLED LEASH WALKS (5-10MIN)(3-4 TIMES/DAY)


WEEK 3

1. MOIST HEAT (10 Min Prior to exercise)
2. MASSAGE (10 MIN)(2-3 TIMES/DAY)
3. PROM (AS NEEDED)
4. SHORT AND CONTROLLED LEASH WALKS (15-20MIN)(3-4 TIMES/DAY)
5. SIT TO STAND EXERCISES (5-7 REPS) (3-4 TIMES/DAY)
We call these puppy squats. Basically, you want to get your dog to sit down and immediately stand back up. This encourages extension/flexion of all joints in the rear legs and also works the muscles surrounding his stifle. Do this at a time when your dog is most likely to oblige, like when it is feeding time. If you have to use treats to get your dog to do this, make sure they are low fat.
6. DISCONTINUE POST THERAPY ICING as long as there is no apparent discomfort.

WEEK 4

1. MOIST HEAT (10 Min Prior to exercise) This does not need to be done 3-4 times/day anymore. If your dog seems to enjoy the heat, go ahead and apply it 1-2 times/day.
2. MASSAGE as needed
3. PROM (AS NEEDED)
4. SHORT AND CONTROLLED LEASH WALKS (20+MIN)(3-4 TIMES/DAY)
5. SIT TO STAND EXERCISES (10 REPS) (3-4 TIMES/DAY)
6. Figure 8’s (10 Reps) (3-4 times/day)
To perform figure 8’s, simply walk as if you are following an imaginary 8 drawn onto the ground. The top of the 8 is one circle and the bottom of the 8 is another circle that intersects in the middle. Each top and bottom portion of the 8 should be equal to about a 10 meter circle. If your dog has difficulty balancing this 8, make it bigger. The purpose of the Figure *’s is to increase muscle strength and encourage balance.

WARNING: If you notice any signs of lameness or discomfort while increasing any of the mentioned exercises, revert to the previous week’s level of activity. For example, during week three you notice that your dog becomes very tired after walking for 20 minutes, then return to walking for only 10-15 minutes, until your dog is able to tolerate this level of activity for a few days, then slowly increase time.

WEEKS 5-8

1. DISCONTINUE MOIST HEAT; PROM AND MASSAGE, as long as your dog is consistently using his limb.
2. CONTROLLED LEASH WALKS WITH HILL WORK (20-30 min with 5-10 min hill)(3-4 times/day with hills 1-2 times/day)
Find an incline that is suitable for your dog to walk up and down. While on your daily walks, slowly walk your dog up and down this incline. Begin with about 5 minutes of hill work and slowly increase to 10 minutes after a few days. Hills are great for the quads and hamstrings, which help support the knee.
3. SIT TO STAND EXERCISES (10-15 REPS) (3-4 TIMES/DAY)
4. Figure 8’s (10-20 Reps) (3-4 times/day)
5. CURB WORK (10-20 feet)(3-4 times/day on walks)
Curb work is basically stepping up and off a length of curb while on your walk with your dog. The curb should be appropriate for your dogs height. Any surface that has some height can be used for this purpose. It does not have to be a curb, but you do need a length of about 20 feet. While on your walk, simply step up and off the curb for a length of 10-20 feet, making an “S” pattern, as you walk on and off the curb. Curb work is great to increase muscle strength, girth, and balance, as well as improve flexion and extension. Go at a pace that is comfortable for your pet. If your dog seems to have any difficulty with this exercise, do not perform it at this time.


WEEKS 8-12
NOTE You are now nearing the end of total recovery, these next few weeks are the strengthening period. These exercises can be used a guideline for your to challenge your dog in a variety of ways, while regaining lost strength and muscle.

1. STAIR WORK(5-7 steps in a row)(1-3 times/day)
At this stage, you can begin to incorporate stairs as a form if exercise. Start with your dog on a leash and if needed, a towel under the belly to support him. Walk slowly up about 3 stairs to start and then slowly back down. Increase the number of stairs and the frequency of the stairs each week. DO NOT give your dog free access to stairs yet, it is still too early.
2. SUPERVISED, OFF LEASH OR LONG LEASH WALKS
3. CONTROLLED LEASH WALKS WITH HILL WORK (30 MIN TOTAL, WITH 1O MIN ON HILLS)(3-4 TIMES/DAY)
4. SIT TO STAND EXERCISES (10-15 REPS) (3-4 TIMES/DAY)
5. Figure 8’s (20 Reps) (3-4 times/day)
6. CURB WORK (20 feet)(3-4 times/day on walks)
7. JOGGING (intervals of 20 feet)(3-4 times/day)
If possible, while on walks, get your dog to jog for a length of only 20 feet and then stop. Jogging increases muscle strength and girth.
8. SWIMMING (5-10 min)(1-2 times/week)
Swimming can be performed as long as your vet approves. It is best done in a controlled environment, preferably in a pool and under direct supervision. Your dog should be lifted into and out of the body of water and held in place or allowed to swim with assistance for about 2-5 minutes. Your dog should not be allowed to jump into or out of the water to swim. Swimming is great for increasing muscle and range of motion. Your local canine rehab facility is a great place to perform this exercise.


CRYOTHERAPY=ICING
Cryotherapy, the use of cold in healing, is the most underutilized therapy in vet medicine today. If you were to have knee surgery, you would leave the OR with your leg immobilized in an inflatable icing unit and then you would undergo aggressive icing thereafter. It should not be any different for your dog. Cryotherapy is extremely important for the 1st 72 hours after surgery. It is almost important after an acute injury or strenuous exercise. It works by stimulating constriction of the blood vessels, thereby slowing circulation to the injured are and preventing many of the bad inflammatory mediators from harming tissue. The cold also slows nerve conduction velocity as well, decreasing localized swelling.


HOW TO’S:
Any of the following can be used: commercial cold gel packs, ice wrapped in cloth, or a bag of frozen peas. When icing, it is best to perform while your dog is lying on it’s side, relaxed. Place the cold source directly over or around the affected area. If your dog reacts to the direct application, try laying a towel between the cold source and the skin. Each icing session should lat 10 minutes.


MOIST HEAT THERAPY
WARNING: Before applying heat to your dog, test the surface temperature of the heating unit to your own skin and hold for 20 seconds. If it does not burn you, it should not burn your dog.

Moist heating is the 2nd most underutilized therapeutic modality in vet medicine. Moist heat is recommended versus dry heat due to the fact that the moisture allows the heat to penetrate deeper into tissue. Heat therapy is NOT to be used until at least 72 hours post surgery. It is contraindicated during any acute inflammatory process, over open woulds, edema or cancerous tissues.

HOW TO’S:It is best to utilize moist heating prior to performing PROM, stretching and exercise to ensure full benefits. There are a number of commercial heating packs available. Like cold therapy, it is easiest to perform the heat therapy while your dog is lying down and relaxing.

6 week recheck and xrays

I took Harley back out to Pcola today for her 6 week check up with Dr. Goett. They just love her out there! But who wouldn't love her. haha Their facility is so nice and the people there are just great.

Her xrays look good. Her bone is healing, but of course, not completely healed yet. I understand it can take upwards of 10+ weeks for bone to heal completely. But Dr. Goett said that he didn't feel that she could do anything at this point to hurt her leg. He said that it was healing good and there was no fluid or inflammation on the joint.

I inquired as to her limp. He said that "most" dogs are NOT limping at 6 weeks...but she is and I'm worried. He said that some dogs just take longer and of course, my Harley is going to be one of those dogs. I asked when I should be worried and he said if she's still favoring it and limping in 3 to 4 weeks, to bring her back and we'd recheck things.

At this point, she's doing so much better and walking better this week then last week. So, we will just wait and see how she does. Her spirits are so much better...she's eating...SOMETIMES! Now, it's a game of will...so I'm not playing it. If she shows no interest, I pick it up. That's it. She'll figure out I'm not playing pretty soon.

I took her to the dog park in Pcola after her appointment. Not so she could run around, but I was meeting a lady out there that's interested in adopting a mastiff in rescue. Harley is such a fuddy dud! She was SO not interested in anything out there. Other dogs would come up and want to play....she wanted nothing to do with it. Oh, she was nice to them, no aggression or anything...but stuck up is more the word I'm looking for. She's so "not a dog". haha

It's been 6 weeks....

Well, tomorrow is officially our 6 week point. I have an appointment on Wednesday, 1/28 to take little Miss Harley back for her 6 weeks xrays. I just pray that everything is healing OK. She seems to be doing great. She's walking so much better lately. She still favors it a lot and she still limps...but she's putting more weight on it. It's like sometimes she walks almost normally...then she remembers that she is supposed to limp and starts limping again.

We have been walking so much and she still puts more weight on the toes of that bad leg, that her little paw pads got worn down and she was bleeding. Road rash...poor girl. So, lately, we have just been walking in the grass. There is a big retention pond behind my house....there's never any water in it...so we go back there, circle the pond a few times...and then do our hill work. She sure doesn't like the hill work, but it's a great workout for both her and ME! :-) I think I can see a difference in her walking since we have been doing it.

She's allowed back on the couch now.....there is no jumping to it, so I figured it can't hurt. She's a much happier girl. She's also allowed on the bed, but only with assistance up and off.

She's still being VERY picky about eating. The week before last, Shawn was out of town...the little brat ate every meal, morning and night. He got home last weekend and all of a sudden she decided that she didn't want to eat again. At this point, it's a pity party, so I'm not babying her. If she doesn't show any interest in her food by the time Koda is finished, I pick it up and save it for the next meal. She just doesn't get it though. Shawn keeps telling me to only feed her at night...for a few days i did that and it worked out fine...I just hate feeding her only one big meal. But if it works, I guess that's what I need to do. She's just not a morning dog like Koda is.

I got my homeopathic remedy in.....Phosphorus....which is more known to help the body clean itself after surgery. I gave a dose of the remedy on Sunday night. I think it helped some as she's much happier, feels much better and is very playful for the 1st time in a long time. Now if I could just get her to eat normally, I'd feel so much better.

So, I'm praying that her xrays come out normally on Wednesday and there's no setbacks. I don't think there will be, but you just never know.

Turning a corner?

I think we are finally turning a corner to Harley's recovery. Monday, 1/12 will be 4 weeks. OMG, is that all? When will it end?

1st thing, we had a scare with Koda. He was really sick on Monday, vomited his meal up and lethargic all day. Koda had intestinal blockage surgery back in June, and then in July and August, his system just shut down and quit processing food. But since August, he's been great...until Monday. So, he ate ice cubes all day on Monday and I took him to the vet on Tuesday. They diagnosed him with Giardia, an intestinal parasite obtained from drinking nasty water. And yes, I kept yelling at him for drinking out of the baby pool....and would empty it. But there's just something about rain water that dogs love. So, 10 days of Flagyl and he's already doing tons better. I made up a big batch of chicken and rice and he's in doggy heaven.

So, as far as the eating thing is going....she ate! :-) On Wednesday, I started her on the alfalfa tablets, 2 tablets, 2 times a day with her meals. I think they are working. She ate Thursday p.m. on her own, no begging, no prodding, and no force feeding her. She ate Friday night and Saturday a.m. on her own! I'm so happy. She's helping Koda eat the chicken and rice...but I don't care what she eats as long as she eats. And she ate from her bowl, standing up. That's a first. I didn't have to hand feed her. I'll continue cooking for her for now, and if she continues like she is and doing great on the eating thing, she'll be switched back to raw in no time.

She also has so much more spunk and energy lately. It has to be the food. I know I sure would be happier if I ate. For week 3, we should have been doing about 15-20 minute walks...but she just had NO energy, so we'd walk to the stop sign and back, about 7 or so minutes and she would just be tuckered out to the max. We did our first around the block walk yesterday, 17 minutes and she did great. We did it this a.m also and she was a little tired, but still good. We have to work her leg out and get her energy up. She has to heal. Today on our walk though, a big German Shepherd came charging at us, so she kind of tried to take off. I hope she didn't use that leg too much. I've even had to start using her harness again, as just on collar now, she pulls way too much. So, on harness today, she was a perfect walking angel!

Here's a couple videos of her limp and how she walks right now. Her good leg is so strong and so muscular and she so uses it for everything. But we are getting there.

http://s21.photobucket.com/albums/b270/chelsnshawn/?action=view&current=January2009010.flv

http://s21.photobucket.com/albums/b270/chelsnshawn/?action=view&current=January2009011.flv

I also will be getting my homeopathic remedy's this coming week. I asked for a consult for three main issues: her appetite; her incontinence (which has gotten way worse since surgery) and one to help her leg heal. Fingers crossed that she'll just continue to get better each and every day!

Harley still not eating

Well, Miss Harley is still not eating. Some days she will have a bite or two, but that's it. I have tried everything you can throw out or think of. I'm basically force feeding her right now just to keep her energy up.

I have consulted with a homeopath Magda Aguila (http://www.aquilinedanes.com/) and am awaiting her advice and remedy's. I will update when I get them and with what she says. This is just not normal.

3 weeks post op

I have been slack on updating my blog and posting online. I'm sure glad the Holiday's are over with. I know I shouldn't think like that, but it's a new year and this one is going to be great.

Harley is still limping and toe touching. From talking to my ortho and others, it's completely normal, even though I'm still a worried mom. If we are in the house or she's just standing, she doesn't put any weight on it at all. If we are walking, she does put weight on it, although again, it's still somewhat on her toe. But it's been raining the last couple of days, so we haven't had many walks either. She lets me do her PROM exercises, although she sure doesn't like it. She keeps her surgery knee drawn up close to her, so I really try to stretch it out as to keep it from getting to stiff. The TPLO surgery is a totally new mechanism to her knee....so, I guess it's just weird to re-learn to walk on it. But her leg looks wonderful, her incision and scar looks great and her hair is starting to grow back.


She's still not eating like she should be. She shows interest in food and will walk over to her bowl and sniff....but walk away and go lay down. If I go over and hand feed her, she'll for the most part eat, but she's still not eating near enough. She typically got about 3lbs of food a day and right now, on her own, she's probably only eating half of that. I am still force feeding her quite a bit....it's gotten pretty easy, I just open her mouth, put whatever on the back of her tongue and down the hatch it goes. Shawn says I need to stop that...and when she gets hungry, that she'll eat...but my opinion right now is that she needs food for energy to heal...no food, no energy, no healing. Even on her walks, she tires very quickly....which to me, is a food/energy thing.


So, at this point, I think she's not eating pretty much out of spite. I know people say dogs don't show "emotions", but this one does. I think she's depressed and doesn't understand why she's back in her cage and can't get on the couch or snuggle in bed with us. It's not her fault, but she doesn't know that. We are giving her more "freedom" around the house now. As long as I'm in the house and can watch her, I'll leave her cage door open so she can come and go. She knows she's not allowed on the couch, but I wouldn't trust her not to try if I wasn't watching her. And for the most part, she'll come out and lay down by the couch or on her bed, or even just chill in her cage. I'm also letting her have more freedom outside offleash. I know you are not supposed to let them outside offleash for fear that they'll take off running or playing...but seriuosly, I don't worry about that with Harley. All she does is walk the yard and for the most part, just sit on the steps and enjoy the fresh air. I can see a difference in her mood and personality with the freedom.


She's obviously still not right yet...we still have a long road ahead of us. I just want her to be better. She was kind of walking stiff yesterday and my demented brain told me she was limping on her other leg.....my worse fear is the other ACL tearing also, which is a possibility. But DH says I'm crazy and that leg looks fine.


Here's some pics over the last couple of weeks.


This was day 2....December 17th. She never really did swell all that much or bruise. I gave her Arnica Montana (homeopathic remedy) and I think it really helped.







12/21 pic....6 days post op. Looking great.

12/25 10 days post op (staples come out 12/26)

And pics from today, 1/3

Today she's limping more

I guess we overdid her yesterday, as today she's toe tapping and walking on her toes just like before surgery. She's also holding that leg up when we come to a stop. So, maybe we just over walked her yesterday and I'm going to just let her rest up today. If not better by tomorrow, I'll call her Ortho.

She's also still not eating. I seriously don't know if she's just being stubborn or if there is something wrong with her. She did eat some turkey and broth and rice last night (with baby food and yogurt mixed in)....but nothign this a.m. So, I mixed up some canned evo, cooked up a bit of heart (now that stunk), some yogurt and baby food and force fed her this a.m. I hate doing it, but she needs substance. Maybe she's just not hungry cause she's not getting much exercise...or maybe she's depressed...or maybe there is something wrong with her...uuurrrggghhh! It's just frustrating.

Her next vet appt is on Friday...so hopefully she'll be fine and we can just all move on.